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    Endoscopic ultrasonography/ Endoscopic ultrasound (EUS)

    Endoscopic ultrasonography (EUS) is a modern technique through which allows your doctor to Simultaneously examine inner lining as well as the walls and surrounding structure of gut. The upper and lower gastrointestinal tract can be evaluated, including esophagus, stomach and duodenum; the lower tract includes your colon and rectum. Also, other organs that are near the gastrointestinal tract, including the lungs, liver, gall bladder and pancreas can be accessed.

    It also carries the advantage of performing minimal invasive procedures as an alternative to open surgeries/biopsies. Fine-needle aspiration or sample (biopsy) fluid and tissue from your abdomen or chest for analysis are possible by EUS. This way, in many cases exploratory surgery can be avoided. EUS techniques are very useful in draining pseudocysts, a procedure which traditionally required open surgery.

    Who needs Endoscopic ultrasonography? Indications of EUS

    Endoscopic ultrasonography can be done for diagnosis as well as minimal invasive intervention in following cases:

    • Cancer of the colon, esophagus, lung, pancreas or stomach, and ampullary and rectal cancers – superficial gut cancers can be removed after ensuring about the depth of spread through the wall.
    • Pancreatitis and pancreatic pseudo-cysts drainage
    • Lymphoma of the gastrointestinal tract
    • Barrett’s esophagus evaluation and taking biopsy
    • Neuroendocrine tumors removal, eg. GIST
    • Bile duct stones removal
    • Sarcoidosis

    EUS can help:

    • To assess the tumor depth through wall of esophagus, stomach, rectum, etc. Infact, pancreatic and lung cancers extent can also be evaluated
    • Staging of cancer of Gastrointestinal tract
    • Nodal status – To evaluate the spread (metastastasis) of tumor to your lymph nodes or other organs
    • Non-small cell lung cancer, which is otherwise difficult to evaluate, can be easily done by EUS.
    • Pancreatic pseudocyst drainage and other abnormal collections of fluid in the abdomen
    • Also, delivering medication directly into the pancreas, liver and other organs is possible with EUS.

    How is Endoscopic ultrasound performed?

    EUS is mostly done as outpatient procedure under local anesthesia or sedation.
    1. Endoscopic ultrasound is done by a thin tube with an inbuilt camera at the tip of tube. This also has a probe to perform ultrasound of surrounding structures. It transmits images to a video monitor in the examination room.
    2. You may receive either a throat spray with a numbing solution or sedation, and pain alleviating medications through a vein.
    3. A mouthpiece will be placed in your mouth first. It does not interfere with your breathing.
    4. You will lie on your side during the procedure.
    5. Your doctor will pass Endoscopic ultrasound probe through mouth, evaluate the whole of esophagus (food pipe), stomach and first part of the small intestine. The endoscope also does not interfere with your breathing. One should keep breathing slowly at that time. EUS examination of the lower gastrointestinal tract is more or less like colonoscopy.
    6. Most procedures take 30- 45 minutes, including biopsy. However, if a procedure is to be done, for eg, draining of psedocyst of pancreas, or FMAC from a lymph node or mediastinal cavity.

    How to prepare for Endoscopic ultrasound / What are the precautions before Endoscopic ultrasound?
    For EUS of upper GI tract-

    1. Do not eat or drink anything 6 hours before undergoing Endoscopic ultrasound.
    2. Dress comfortably and wear loose clothes.
    3. Come with an attendant to arrange for a ride back home.

    If you have any co-morbidities (like hypertension, diabetes, heart condition or bleeding disorder, do inform doctor beforehand). If you are consuming any chronic medicines, then they need to be reviewed weather to continue or not before the procedure.
    For EUS of Lower GI Tract, one has to prepare like colonoscopy, i.e. only liquid diet in the prior 24 hours. Do take laxatives in the prior 24 hours to clear your bowels. In case of any problem or constipation, do inform the nurse who will arrange for an enema.
    In case, some minimal invasive intervention has been planned, weather of mediastinal cavity, gut, pancreas, liver, etc.; do take extra precautions and discuss beforehand with your attending doctor.

    IMPORTANT Frequently Asked Questions

    Q. What to expect after Endoscopic ultrasound / Who performs Endoscopic ultrasound?
    A. EUS is a highly specialized procedure. It is to be done by the gastroenterologist with a special training and experience in the field.
    Post- procedure, you may experience some numbness or throat irritation, which will relieve with lozenges or warm water after some time.
    In case of only diagnostic EUS has been done, you may start with clear liquids after 30 minutes.
    If, Some intervention, like biopsy or tumor resection has been done, it is better to consult with your physician regarding the diet.

    Q. Risks of Endoscopic ultrasound/ Can EUS cause pancreatitis?

    A. EUS is a very safe procedure. 1% to 2% of patients will suffer from Pain, acute pancreatitis, infection and bleeding. Risks associated with EUS-FNB are affected by experience of endoscopist and also target lesion and associated comorbidities.
    Advanced procedures do carry some risk of hemorrhage, Infection, perforation, Acute Pancreatitis. A few cases of needle tract seeding and peritoneal dissemination have also been reported.

    Q. What is Endoscopic ultrasound cost in India?

    A. As a large variety of cases are done by EUS nowadays, the cost will depend n the type of procedure performed. It is better to discuss beforehand with your doctor/ insurance provider.

    Q. Is Endoscopic ultrasound covered in medical insurance?

    A. Most of the cases done by EUS come under essential medical services, hence covered by insurance. However, one must reconfirm this with insurance provider.

    Q. Endoscopic ultrasound for pancreas?

    A. As pancreas is a retroperitoneal structure, i.e. hidded behind peritoneum, it is difficult to evaluate with traditional methods. Here, EUS plays a very key role.
    It can be used to differentiate between different pancreatic pathologies like Pancreatic masses, cysts and tumors. It helps in evaluating Chronic/ Acute pancreatitis, Autoimmune pancreatitis.
    EUS is done in line with the CT/ MRI findings. It is very useful in doubtful cases, where exact cause could not be found even after CT/ MRI is done. Cases like Dilated pancreatic duct, Dilated bile duct, Swollen/inflamed pancreas, Suspected stones in the pancreas duct or bile duct, Suspected blockage of the pancreas or bile duct, History of recurrent episodes of acute pancreatitis. Pancreatic biopsies, drainage of cysts, site specific delivery of medicines are performed via EUS.

    This information is intended only to provide general guidance and not an alternative to formal medical advice. Itt is very important that you consult your doctor about your specific conditions.