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What is an endoscopic ultrasound?
Endoscopic ultrasound involves the use of a flexible video instrument (endoscope), which has an ultrasound probe at its tip. This procedure is a highly specialized endoscopic procedure and only became available in Queensland in 2002. It is used to examine the wall layers of the gastrointestinal tract and therefore normal or abnormal structures that arise from it. In addition, it provides excellent images of the structures outside the gut wall like the pancreas, bile ducts and structures in the chest (mediastinum). EUS provides detailed assessment of tumours involving these structures and can help you and your doctors determine the most appropriate treatment. The instrument is passed over the back of your tongue into the upper gastrointestinal tract in the same way a regular endoscopy is performed.
Common Reasons to require an EUS
· Tumours of the oesophagus, stomach, duodenum, pancreas, bile ducts.
· Some tumours of the lung
· Gall bladder and bile duct abnormalities, including gall stones.
· Abnormalities of the wall of the upper gastrointestinal tract
What to bring:
- Wear loose, comfortable clothes
- Your Medicare card, private health fund and pension or Veterans Affairs details if applicable
- A current referral from your GP or a referring specialist (if not sent through prior)
- The contact name and telephone number of someone who will take you home
How are you prepared?
You are to consume NO FOOD from midnight the day of your procedure. If your appointment is later in the day you may have CLEAR FLUIDS ONLY until four hours prior to your procedure. You should then be Nil By Mouth (i.e. no food, fluids, water, smoking) until after your procedure.
What will happen?
The doctor and/or nurse will explain the procedure and answer any questions you have. Please inform us if you have had any previous endoscopic examination or any bad reactions to sedatives or other medications. You will need to remove your dentures. Please inform the staff if you have any loose teeth or crowns. Also notify the staff if you are known to have a heart murmur as you may require antibiotics before the procedure.
At the beginning of the procedure your throat will be sprayed with a local anaesthetic and you will be given a sedative by injection in a vein to make you more comfortable. You will be asked to lie on your left side and a guard will be placed in your mouth to protect your teeth. You will be sleepy for about half an hour afterwards.
You will remain in the endoscopy unit for up to 3 hours until the main effects of the sedation wear off and you have had something to eat/drink. You may feel slightly bloated due to the air that has been introduced through the endoscope. This will quickly pass. Your throat may feel sore. You should not attempt to eat or drink anything until your swallowing reflex has returned to normal. After this you may return to a normal diet, unless otherwise instructed. You should avoid alcohol for 12 hours after your procedure.
· For legal reasons you must not drive a vehicle or operate machinery for at least 12 hours following intravenous sedation. Failure to do so carries the same implications as drink driving.
· You must have a responsible adult escort you home (i.e. you should not go to work) and stay with you for 12 hours after the procedure. Also you should not care for dependent persons without responsible help for at least 12 hours after your procedure.
· You are also advised to be very careful in simple household tasks in the 12 hours after receiving sedation. Your coordination may be impaired for some time and it is important, therefore, not to use sharp knives, risk kitchen burns etc.
If you develop any pain, fever, vomiting or blood loss after the procedure, you should contact your doctor immediately or the hospital where your procedure took place. Alternately, after hours, you can contact our after hours service on 3261 9570.
If you have serious heart or chest problems, special precautions need to be taken to reduce any possible risk. You should therefore inform your doctor of any serious illness of this nature. The precautions taken will usually include providing oxygen during the procedure and/or monitoring the heart and oxygen levels during the procedure. You may require antibiotics before or during the procedure.
The most commonly used imaging tests that may offer similar information to EUS are computed tomography scans (CT) and magnetic resonance imaging (MRI). You may already have had these tests performed or they may be required in the future depending on the results of the EUS and the recommendations of Dr Devereaux/Dr Walsh or one of your other treating doctors. EUS may be the best test in your situation or may offer additional or complimentary information to these other tests.
Safety and risks
Endoscopic ultrasound is usually a safe procedure. The risks associated with EUS are the same as for regular upper gastrointestinal endoscopy. It is unlikely to cause problems for patients unless they have serious heart or chest problems.
Rarely patients may have a reaction to the sedation. Damage to the oesophagus at the time of examination is extremely rare unless there is pre-existing oesophageal disease. Such complications are extremely rare. Other potential complications include bleeding, infection and perforation (hole/tear) in the wall of the upper gut. If you wish to have full details of all possible rare complications discussed before the procedure, you should inform your doctor. The overall complication rate is less than 1 in 1000 procedures.
A copy of the results will be sent to your referring doctor and be provided to you on the day of the procedure or within 3 working days. A full report and assessment will be sent to your referring doctor within approximately 3 days. Your treating specialist will contact you if he has any serious concerns or if you require a further appointment with him. Should you have any questions or concerns contact our practice nurse at Digestive Diseases Queensland.