Re: What will EUS show?

August 19, 2004

Endoscopic Ultrasonography or EUS is a state of the art technology. As the

name implies, this procedure combines endoscopy and ultrasound. As in

traditional endoscopy, a flexible endoscope is inserted into the GI tract

through either the mouth or the rectum providing capability to view the

intestinal lining. The ultrasound probe located on the endoscope further

provides unparalleled images of internal organs, lymph nodes and other

structures by utilizing sound waves. These same images may not be detectable

by traditional CAT scan or MRI. Images can be photographed or videotaped as

high-resolution pictures and if needed, tissue samples or biopsies of

suspicious looking growths are possible. EUS is very safe and does not

employ any radiation, only sound waves.

EUS is particularly useful in the diagnosis of cancers and if found,

determining the depth of invasion into surrounding tissues. Some examples of

conditions where EUS is helpful include cancers of the esophagus, pancreas

or rectum. In these situations, EUS may determine how much surgery is

necessary as well as whether surgery is likely to cure the underlying

disease. EUS is also useful in identifying many non-cancerous conditions

such as abnormalities of the pancreas and bile ducts and since EUS

technology is still in its infancy, we expect even more uses for diagnosis

and therapy in the future.

EUS is performed in an outpatient setting under sedation with a brief

recovery period following the exam. The procedure itself requires

approximately 30 minutes. After the exam, patients can typically expect a

two (2) hour stay in the short stay unit. You will need a ride home from the

hospital after your procedure.

I hope this finds you and yours well

Mark E. Armstrong

casca@...

www.top5plus5.com

PAI NW Rep

ICQ #59196115

What will EUS show?

> Hi all. My doc is going to schedule an EUS in the fall. He doubts

> it will show anything. I'm just wondering what it shows and what it

> can detect? For those who don't know I have pancreas divisum and

> that is the only abnormality with my pancreas. Both MRCP and ERCP

> haven't shown any evidence(according to my doc) of pancreatitis.

> Will the EUS be able to show if my minor papilla is too narrow and

> backing up juice? My dorsal duct isn't dilated on any tests

> either. Thanks for any responses. Jen

>

August 19, 2004

Understanding EUS (Endoscopic Ultrasonography)

You've been referred to have an endoscopic ultrasonography, or EUS, which

will help your doctor, evaluate or treat your condition. This brochure will

give you a basic understanding of the procedure - how it is performed, how

it can help, and what side effects you might experience. It can't answer all

of your questions, since a lot depends on the individual patient and the

doctor. Please ask your doctor about anything you don't understand.

Endoscopists are highly trained specialists who welcome your questions

regarding their credentials, training and experience

What is EUS?

EUS allows your doctor to examine the lining and the walls of your upper and

lower gastrointestinal tract. The upper tract is the esophagus, stomach and

duodenum; the lower tract includes your colon and rectum. EUS is also used

to study internal organs that lie next to the gastrointestinal tract, such

as the gall bladder and pancreas.

Your endoscopist will use a thin, flexible tube called an endoscope. Your

doctor will pass the endoscope through your mouth or anus to the area to be

examined. Your doctor then will turn on the ultrasound component to produce

sound waves that create visual images of the digestive tract.

Why is EUS done?

EUS provides your doctor more detailed pictures of your digestive tract

anatomy. Your doctor can use EUS to diagnose the cause of conditions such as

abdominal pain or abnormal weight loss. Or, if your doctor has ruled out

certain conditions, EUS can confirm your diagnosis and give you a clean bill

of health.

EUS is also used to evaluate an abnormality, such as a growth, that was

detected at a prior endoscopy or by x-ray. EUS provides a detailed picture

of the growth, which can help your doctor determine its nature and decide

upon the best treatment.

In addition, EUS can be used to diagnose diseases of the pancreas, bile duct

and gallbladder when other tests are inconclusive.

Why is EUS used for patients with cancer?

EUS helps your doctor determine the extent of certain cancers of the

digestive and respiratory systems. EUS allows your doctor to accurately

assess the cancer's depth and whether it has spread to adjacent lymph glands

or nearby vital structures such as major blood vessels. In some patients,

EUS can be used to obtain tissue samples to help your doctor determine the

proper treatment.

How should I prepare for EUS?

For EUS of the upper gastrointestinal tract, you should have nothing to eat

or drink, not even water, usually six hours before the examination. Your

doctor will tell you when to start this fasting.

For EUS of the rectum or colon, your doctor will instruct you to either

consume a large volume of a special cleansing solution or to follow a clear

liquid diet combined with laxatives or enemas prior to the examination. The

procedure might have to be rescheduled if you don't follow your doctor's

instructions carefully.

What about my current medications or allergies?

Tell your doctor in advance of the procedure about all medications that

you're taking and about any allergies you have to medication. He or she will

tell you whether or not you can continue to take your medication as usual

before the EUS examination. In general, you can safely take aspirin and

nonsteroidal anti-inflammatories (Motrin, Advil, Aleve, etc.) before an EUS

examination, but it's always best to discuss their use with your doctor.

Check with your doctor about which medications you should take the morning

of the EUS examination, and take essential medication with only a small cup

of water.

If you have an allergy to latex you should inform your doctor prior to your

test. Patients with latex allergies often require special equipment and may

not be able to have an EUS examination.

Do I need to take antibiotics?

Antibiotics aren't generally required before or after EUS examinations. But

tell your doctor if you take antibiotics before dental procedures. If your

doctor feels you need antibiotics, antibiotics might be ordered during the

EUS examination or after the procedure to help prevent an infection. Your

doctor might prescribe antibiotics if you're having specialized EUS

procedures, such as to drain a fluid collection or a cyst using EUS

guidance. Again, tell your doctor about any allergies to medications.

Should I arrange for help after the examination?

If you received sedatives, you won't be allowed to drive after the

procedure, even if you don't feel tired. You should arrange for a ride home.

You should also plan to have someone stay with you at home after the

examination, because the sedatives could affect your judgment and reflexes

for the rest of the day.

What can I expect during EUS?

Practices vary among doctors, but for an EUS examination of the upper

gastrointestinal tract, your endoscopist might spray your throat with a

local anesthetic before the test begins. Most often you will receive

sedatives intravenously to help you relax. You will most likely begin by

lying on your left side. After you receive sedatives, your endoscopist will

pass the ultrasound endoscope through your mouth, esophagus and stomach into

the duodenum. The instrument does not interfere with your ability to

breathe. The actual examination generally takes between 15 to 45 minutes.

Most patients consider it only slightly uncomfortable, and many fall asleep

during it.

An EUS examination of the lower gastrointestinal tract can often be

performed safely and comfortably without medications, but you will probably

receive a sedative if the examination will be prolonged or if the doctor

will examine a significant distance into the colon. You will start by lying

on your left side with your back toward the doctor. Most EUS examinations of

the lower gastrointestinal tract last from 10 to 30 minutes.

What happens after EUS?

If you received sedatives, you will be monitored in the recovery area until

most of the sedative medication's effects have worn off. If you had an upper

EUS, your throat might be sore. You might feel bloated because of the air

and water that were introduced during the examination. You'll be able to eat

after you leave the procedure area, unless you're instructed otherwise.

Your doctor generally can inform you of the results of the procedure that

day, but the results of some tests will take longer.

What are the possible complications of EUS?

Although complications can occur, they are rare when doctors with

specialized training and experience perform the EUS examination. Bleeding

might occur at a biopsy site, but it's usually minimal and rarely requires

follow-up. You might have a sore throat for a day or more. Nonprescription

anesthetic-type throat lozenges and painkillers help relieve the sore

throat. Other potential, but uncommon, risks of EUS include a reaction to

the sedatives used; backwash of stomach contents into your lungs; infection;

and complications from heart or lung diseases. One major, but very uncommon,

complication of EUS is perforation. This is a tear through the lining of the

intestine that might require surgery to repair.

The possibility of complications increases slightly if a deep needle

aspiration is performed during the EUS examination. These risks must be

balanced against the potential benefits of the procedure and the risks of

alternative approaches to the condition.

Additional Questions?

If you have any questions about your need for EUS, alternative approaches to

your problem, the cost of the procedure, methods of billing or insurance

coverage, do not hesitate to speak to your doctor or doctor's office staff

about it.