Endoscopic Ultrasound: Indications and Complications

Endoscopic ultrasound (EU) is a method for examination and visualisation of upper and lower gastro intestinal tract and related organ with the help of sound waves. Along with examination it can be used for obtaining ultrasound guided needle biopsies also.

Procedure

Upper GI EU

For this procedure your doctor will spray a local anaesthetic in your throat to prevent gagging. You may be administered a sedative intra venously to help you relax during the procedure. You will be asked to lie on a table on your left side. Your doctor will then insert a thin tube with a small ultrasound probe at its tip into your food pipe via your mouth. The tube will then be inserted into the stomach and then the duodenum. Using the probe your doctor can also examine the pancreas, liver and the gallbladder.

Lower GI EU

This procedure can be performed without anaesthesia. Your doctor will insert the endoscope into your large colon via the anus and rectum. If a suspicious mass is encountered your doctor will like to take a sample for further evaluation.

Indications for Endoscopic Ultrasound

• Evaluation a disease in the pancreas
• Characterising disorder of gallbladder and bile duct
• When there is suspicion of cancer: an EU helps in looking for the characteristics of a mass and if cancerous, the extent of its spread
• Guiding drainage of abnormal fluid collection in the abdomen
• Barret’s oesophagus
• Precise targeting for delivery of medication to the liver or the pancreas

Preparation

Depending upon whether you are undergoing an upper or lower GI EU your doctor might ask you to not eat or drink 12 hours prior to the procedure or prescribe laxatives for a clear colon respectively. Not adhering to these instructions may lead to rescheduling of the procedure. Before the procedure your doctor would like to know the medication that you’ve received till then and may ask you to stop some medications like blood thinners to prevent excessive bleeding at the site from where the sample of tissue has been obtained from. Inform your doctor about any allergies to sedatives or anaesthetics beforehand. Your doctor would also like to know if you have any bleeding disorder or have a family history of the same. Another allergy that your doctor would like to know about is latex allergy.

Complications of Endoscopic Ultrasound

EU is a relatively safe procedure. Complications seen are:

• Bleeding from the site where tissue sample has been taken
• Infection
• Perforation of intestine: this is an emergency and will require a surgery for repair
• Pancreatitis: if a fine needle aspiration has been performed.

Recovery

You are requested to arrange for someone to drive you home after the procedure as the effects of the sedative take time to wear off. You will be allowed to go home on the same day. if you experience any of the following you are requested to contact your doctor immediately

• Tarry black stool
• Fever
• Abdominal pain
• Shortness of breath
• Chest pain

Resources:

• American Gastroenterological Association
• American Society for Gastrointestinal Endoscopy