Endoscopic ultrasound (EUS)

Endoscopic ultrasound (EUS) is a minimally invasive procedure to assess digestive (gastrointestinal) and lung diseases. A special endoscope uses high-frequency sound waves to produce detailed images of the lining and walls of your digestive tract and chest, nearby organs such as the pancreas and liver, and lymph nodes.

When combined with a procedure called fine-needle aspiration, EUS allows your doctor to sample (biopsy) fluid and tissue from your abdomen or chest for analysis. EUS with fine-needle aspiration can be a minimally invasive alternative to exploratory surgery.

EUS techniques are also used in certain treatments, such as draining pseudocysts.

EUS is performed on an outpatient basis and is well-tolerated by most people.

You may not be a candidate for EUS if you have had abdominal surgery that changed your anatomy, such as Roux-en-Y gastric bypass.

Endoscopic Treatment for Pancreatic Disease - Columbia University Department of Surgery

Endoscopic Ultrasound (EUS)

How it works: EUS is one of the most useful imaging studies for diagnosing pancreatic cancer. An outpatient procedure, it provides detailed images of the pancreas and surrounding tissues including the liver, blood vessels, and lymph nodes. EUS relies on high frequency soundwaves to create a picture of the organs. When the soundwaves bounce off of the internal organs, they send echoes to a computer which creates a visual image.

EUS involves passing a thin lighted tube, called an endoscope, through your mouth then into your stomach and duodenum. The ultrasound probe is attached to the tip of the endoscope. Since the endoscope allows the ultrasound probe to get very close to the pancreas and its surrounding organs, detailed pictures can be produced, and small tumors in the pancreas can be detected.

The real-time needle guidance provided by the EUS procedure enables the physician to biopsy a suspicious cyst or suspected tumor in a process called Fine Needle Aspiration (FNA). To learn more about biopsy procedures, click here.

What to Expect: During the test you will be under heavy conscious sedation. Throughout the procedure you will retain a minimum level of consciousness allowing you to breathe on your own and respond to verbal and physical prompts. The sedation should keep you from feeling physical discomfort during the procedure. You will be positioned on your side and once you are properly sedated, the endoscope will be passed through your mouth and into your stomach and duodenum.

If your doctor uses FNA to biopsy a cyst or a mass, you will be given IV antibiotics and asked to take oral antibiotics for a few days at home after the procedure. The EUS procedure takes approximately 1 hour.

Considerations: Due to the sedation, you will not be able to drive yourself home after the procedure and should arrange for someone to pick you up. Complications with EUS procedures are very rare but may include pancreatitis, gastrointestinal bleeding, and adverse reactions to the sedative medication. Infection of a pancreatic cyst after FNA is also possible, and typically antibiotics are given to reduce that risk.

What to Expect at a GI Procedure - Columbia University Department of Surgery

What to Expect at a GI Procedure

How to Prepare for a GI Procedure | What to Expect After a GI Procedure

Pancreas Center endoscopists will strive to ensure your experience is as comfortable for you as possible when you are here. Your procedure will be performed in the Endoscopy Suite on the 13th floor of the Herbert Irving Pavilion. The endoscopic procedures performed at The Pancreas Center are outpatient procedures. This means you will be able to leave the hospital the same day as your exam. Here is a summary of how your day will go:

Arrive and Register – 1 Hour Prior to Scheduled Procedure

When you arrive, you will be asked to fill out some paperwork at the registration desk. Someone on your treatment team will also confirm that you have followed all pre-procedural instructions to ensure you are prepared for endoscopic evaluation.

Anesthesia Consult

Before entering the consultation room, you will be brought to a holding area where an anesthesiologist will speak with you. At that time, your treatment team will decide whether you will receive conscious sedation or monitored anesthesia care, a deeper level of sedation. You will receive an IV at this time through which the sedation medication will be delivered once you are in the treatment room.

Endoscopic Procedure

After your anesthesia consultation, you will be brought into the procedure room and asked to position yourself on the treatment bed. Your treatment team will introduce themselves, confirm the procedure you are having, and answer any questions you may have.

Once you are situated and prepared for the procedure, you will receive the sedative through an IV and the procedure will begin. Throughout the procedure, you will be able to respond to verbal and physical prompts, but the sedation will keep you from feeling any physical discomfort.

Recovery

You will be brought back to a holding area once the procedure is complete. Due to the sedation, you may feel a little sleepy. Once your transportation arrives, you will be able to go home.

ATTENTION: You must arrange for someone to pick you up from the Endoscopy Suite since we cannot allow you to leave unless we are sure you can get home safely.

How to Prepare for a GI Procedure

When you schedule your endoscopic procedure, your physician will give you very specific pre-procedural instructions. It is important that you follow the instructions carefully. The instructions are designed to keep you safe while ensuring the best possible outcome.

Make sure to let your endoscopist know what medications you are currently taking. Patients who take blood thinners like Plavix or Coumadin may be asked to temporarily stop or switch their medication. Special instructions will also be given to patients who are diabetic.

You will be asked not to eat or drink anything after 12 midnight on the day of your procedure. This means no food, gum, or any liquids on the day of your examination. If your endoscopist gives you clearance to take your daily medications, make sure to take them with only a small sip of water.

Due to the sedation, you will not be able to drive yourself home after the procedure. You must arrange for someone to pick you up from the Endoscopy Suite since we cannot allow you to leave unless we are sure you can get home safely.

If you become jaundiced, develop a fever, feel increased pain in your abdomen, or experience a sudden change in your overall well-being, call your endoscopist immediately. These symptoms may indicate your condition has worsened and you may need more urgent intervention.

What to Expect After a GI Procedure

Immediately after an endoscopic procedure, it is normal to feel sleepy and drowsy due to the sedation. This will go away after a few hours. You may also experience some mild discomfort in your abdomen and find yourself passing a lot of gas. This is due to the air that is placed in your belly during the procedure to enable your endoscopist to view your abdominal organs.

You should feel back to normal the day after your procedure. If, however, you experience increased pain or your discomfort does not lessen within a day, please call your endoscopist.

If biopsies were taken during your endoscopic procedure, the results will be ready in five days. You are encouraged to call your endoscopist at that time to learn your results. Your endoscopist will send a copy of the findings and report to your referring physician so further treatment decisions can be made.

Every Thursday morning, the Pancreas Center multidisciplinary team of experts meets to discuss the plan of care for each of our current patients. After undergoing an endoscopic procedure, your case will be presented at this forum where surgeons, radiologists, gastroenterologists and oncologists will discuss the best course of action for your case.

After the conference, your endoscopist will call you to let you know the outcome of the discussion and will refer you to another Pancreas Center specialist for further treatment, as needed.

For more information, call us at (212) 305-9467 or reach us through our online form.

Pancreatic Adenocarcinoma

NCCN Member Institutions vary in the use of additional staging technologies, such as EUS.

The role of EUS in staging is believed to be complementary to CT, providing additional information for patients whose CT scans show no lesion or who have questionable involvement of blood vessels or lymph nodes.30

Because this procedure is operator-dependent, some divergence in use may occur because of differing technical capabilities and available expertise.

...Patients with a mass in the pancreas on dynamic-phase spiral CT but no evidence of metastatic disease should also have a surgical consultation (see page 974).

EUS may provide useful staging information in pancreatic cancer, particularly through assessment of certain types of vascular invasion.44,45 EUS can also be used to evaluate periampullary masses, separating invasive from noninvasive lesions.

In addition, EUS may have a role in better characterizing cystic pancreatic lesions. On EUS, malignant cystic lesions may present as a hypoechoic cystic/solid mass or as a complex cyst and are frequently associated with a dilated main pancreatic duct. Some therapeutic interventions can also be performed with EUS (e.g., celiac block, removal of ascites).

The panel agreed that, although EUS has a high accuracy in assessing involvement of certain veins (e.g., portal vein), it is less accurate in imaging tumor invasion of the SMA.45,46

Endoscopic Ultrasound (EUS) - American Gastroenterological Association

Your doctor may have found a lesion or abnormality at a prior endoscopy study (upper endoscopy or colonoscopy) or on an X-ray test, such as a computerized tomography (CT) scan. An endoscopic ultrasound (EUS) will allow your doctor to see very detailed ultrasound images of the lesion or abnormality. The bowel wall and nearby organs and structures (such as lymph nodes or blood vessels) can also be seen.

If a biopsy (taking a small piece of tissue to look at under a microscope) is needed, fine needle aspiration (FNA) can be performed. Your doctor will use the ultrasound image to guide a thin needle through the endoscope to take the biopsy.

Why Use EUS?

For pancreatic cancer, a doctor can use an EUS to:

Studies using EUS to screen people at higher risk for developing pancreatic cancer are also underway. Contact PanCAN Patient Services to learn more about pancreatic cancer risk and screening studies for people at high risk.

EUS can also be used to treat pancreatic cancer side effects. For example, a pancreatic tumor may cause pain if it presses against the celiac plexus, a bundle of nerves connecting the pancreas and other organs to the brain and spinal cord. To treat this pain, some patients get a celiac plexus block.

The celiac plexus block can happen during an EUS. If patients already have an EUS procedure scheduled and are experiencing uncontrolled pain, they should discuss a celiac plexus block with the doctor before the procedure.

How Does EUS Compare with Other Imaging Tests?

EUS is one of the most common imaging procedures used to diagnose pancreatic cancer. It is also often the best way to get tumor samples to make a definitive pancreatic cancer diagnosis. EUS may be able to find small pancreatic masses that were not found by computed tomography (CT) or magnetic resonance imaging (MRI) scans.

An EUS procedure is like an endoscopic retrograde cholangiopancreatography (ERCP), but the images are different. EUS is generally a safer test than ERCP.

For more information about pancreatic cancer diagnosis and these tests, contact PanCAN Patient Services.

How Should Patients Prepare for an EUS?

The healthcare team gives patients instructions before an EUS procedure.

Patients are not allowed to eat or drink anything six hours before the examination. Some may receive medicines before the procedure to decrease their chance of infection. The doctor tells the patient whether to continue taking these or other medicines before the EUS procedure.

Before the EUS, patients receive sedative medicine to help them relax and a drug to block pain. Patients may feel drowsy during the procedure but stay awake. They should plan to have someone drive them home after the procedure.

What Happens After an EUS?

After the EUS procedure, the patient remains in the recovery room until the sedative medicine has worn off. The patient should not drive a vehicle after the procedure.

Patients may feel full or the need to pass gas after the procedure. Also, the patient may have changes in bowel habits, such as soft stool. The healthcare team provides instructions on eating and drinking after an EUS.

What Are Possible Side Effects?

EUS complications are very rare. These may include:

We’re Here to Help

For more information about pancreatic cancer diagnosis, contact PanCAN Patient Services.

Other Imaging Tests

Endoscopic Retrograde Cholangiopancreatography (ERCP)

Computed Tomography or Computerized Axial Tomography (CT or CAT)

Magnetic Resonance Imaging (MRI)

Positron Emission Tomography Computed Tomography (PET-CT)