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Endoscopic Ultrasound

Endoscopic Ultrasound

Overview

Endoscopic ultrasound is a method that combines features of endoscopy and ultrasound.  The endoscopy allows examination of the entire digestive tract and organs with lumen, such as lungs, while the ultrasound is concomitantly used to visualize the organs that the endoscope cannot be advanced to. Endoscopic ultrasound is a minimally invasive diagnosis and treatment method.


Since the endoscopic examination of the lungs is called bronchoscopy in the clinical practice, endoscopic ultrasound is used to describe the endoscopic examination and ultrasound imaging of the digestive system and the organs located close the digestive system.


Why is this procedure done?

Endoscopic ultrasound aims to visualize and image esophagus, stomach, small intestine, colon and rectum as well as organs located close to the digestive system, such as pancreas, liver and gallbladder.  While the organs of the digestive system can be directly visualized if the endoscope can be advanced, the nearby organs are imaged with ultrasound scanning.


Endoscopic ultrasound (EUS) allows identifying stenosis, gallstones, cancer, spread or metastasis of cancer, Barrett's esophagus, cysts and inflammations of the digestive tract and nearby organs.


As endoscopy allows diagnosis and treatment in the same session, it is used to diagnose cancers of those organs, the extent of spread and evaluation of response to treatment as well as to take biopsy specimens. Moreover, the imaging guidance offers a chance to administer anti-cancer drugs directly into the liver, pancreas and other organs.


Risks

Possible risks of endoscopic ultrasound are almost identical to that of upper GI endoscopy and colonoscopy. Those risks are extremely rare and they are usually managed easily, even if they develop. Drug reactions and bleeding at biopsy site are the most common ones. The perforation of the digestive tract examined with endoscope is an extremely rare complication.


In the endoscopic ultrasound room, any and all necessary instrument, equipment and other means to manage the possible risks and complications are available.


Our specialists will employ all practices to minimize the risk of complications and our doctors will inform you about risks listed above and all other potential complications and will address all your concerns before the procedure.


Preparation

In both upper GI endoscopic ultrasound and endoanal ultrasound, in which the endoscope is inserted into the rectum, the digestive tract should be clean or in other words, there should be no digested food and stool in the lumen.


In this end, you will be instructed to stop eating and drinking minimum 6 to 8 hours before the procedure and/or to take laxative agent, a drug that empties the colon.


At the preparation phase, you need to notify all prescription and over-the-counter medications that you take to manage diabetes mellitus, hypertension, high blood lipids and cholesterol as well as other diseases and all vitamin and mineral supplements to your doctor. Your doctor will instruct medications that you should stop taking by consulting you with other specialist of our hospitals. Or, dose of those medications can be modified.


Since you will be sedated during the procedure, you will need a family member or a friend to drive you home after the procedure is completed and it is confirmed that your general health is stabilized. If it is not possible, you can seek help from healthcare professionals regarding your transfer to home.


Surgery and early postoperative period

After preparations are completed, you will be transferred to the endoscopy room and be positioned on the procedure table.


Your doctor will administer a sedative agent and thus, you will not feel the procedure. Sedative agents will help you relax and fall into a nap. Accordingly, feeling of cramp or defecation that are caused by the procedure is minimized.


Your vital signs are checked throughout the procedure.


After you are properly positioned on the procedure table, the endoscope will be inserted through the mouth for upper GI endoscopic ultrasound or the colonoscope will be inserted for the rectal endoscopic ultrasound.


Your throat is numbed as you may accidentally bite the endoscope and your oral cavity is injured. A spray is used for this purpose. Moreover, a rubber mouth guard is placed to keep your mouth open.


The endoscope is then advanced into the esophagus through the oral cavity. After mucosa of the esophagus is visualized, the structure and the tone of a circular muscular structure located between the distal end of the esophagus and the inlet of the stomach, called sphincter, is evaluated.


The endoscope is advanced to the stomach and the mucosa in all parts of the stomach (pylorus, antrum, corpus) is examined.  If an ulcer is noted, it can biopsied or coagulated (burnt) with a device, called cautery. Or, some drugs are injected into and around the ulcer in order to form a scar tissue. If an abnormal growth of mucosa is seen, biopsy specimens can be collected before the lesion is completely removed.


Finally, the endoscope is advanced to the duodenum, the first part of the small intestines, and endoscopic examination terminates, after examination, diagnosis and treatment is completed.


Meanwhile, ultrasonographic images of surrounding organs and lymph nodes are captured using the ultrasound probe equipped on the endoscope. Ultrasound-guided needle biopsy specimens are collected, if required.


Endoanal ultrasound is principally used to diagnose, treat and follow up diseases and cancers of the rectum and the prostate gland.


Before you are discharged, your doctor may make dietary recommendations and prescribe medications. You should strictly follow instructions of your doctor in order to prevent risks and to maximize the comfort after the procedure.


A family member or a friend should drive you home, as you are administered sedative agent. If it is not possible, you can seek help from healthcare professionals regarding the transportation.


Distension, frequently passing gas, mild throat ache and irritation are expected symptoms you may experience during and after an endoscopy. However, if you notice fever, shortness of breath, blood or black discoloration of stool and difficulty swallowing or feel insufferable abdominal pain, vomit and see blood in vomit, contact your doctor or visit the closest healthcare facility.


Results

Findings of the endoscopic ultrasound are compiled by your doctor in a report. If a biopsy specimen is collected, results of pathological examination will also be reported. Your doctor will inform you in detail about all findings, treatments, precautions and advices.