Endoscopic Ultrasound (EUS) | Let's learn about it simply

Do you also have a stomach ache, a burning sensation in your chest? Maybe your doctor did a CT scan or MRI and saw something small on it and told you that you need to do a special test to find out more about it. That's what we're talking about today, a very advanced test that is done at such times. Endoscopic ultrasound, or EUS for short. Although the name sounds a bit complicated, it's actually very simple. Let's take a look at the details.

What is endoscopic ultrasound (EUS)?

Simply put, EUS is a procedure used to examine the inside of your digestive system, or intestines. This is done by a gastroenterologist.

Think about it, this is like combining two technologies.

1. Endoscope: This is a long, thin, flexible tube with a camera and light at one end. It can clearly see what's inside your stomach.

2. Ultrasound: At the end of the tube is a small scanning device (probe). This emits sound waves and creates images of the organs, tissues, and blood vessels inside your abdomen.

So when these two are combined, the doctor can take a very close and clear look at the organs inside and around your intestinal walls, like the pancreas and gallbladder. It can see a lot more detail than a regular scan.

Who needs an EUS test?

Doctors recommend this EUS test for various reasons. It is mainly used to accurately diagnose a medical condition or find the cause of a certain symptom.

There are two main types of EUS tests:

Depending on your symptoms, your doctor will decide whether to examine the upper or lower abdomen.

1. EUS (Upper EUS)

In this, an endoscope is inserted through your mouth and the upper part of your digestive system is examined.

• The esophagus, stomach, and first part of the small intestine.
• The surrounding lymph nodes, blood vessels, fluid-filled cysts, and cancerous tumors.
• Nearby organs like the pancreas, gallbladder, and bile ducts.

2. EUS (Lower EUS)

In this, the endoscope is inserted through the anus and the lower part of the digestive system is examined.

• The muscles around the anus (Anal sphincter).
• The surrounding blood vessels, lymph nodes, fluid-filled cysts, and lumps.
• The last part of the large intestine (rectum and colon).

Biopsy test performed simultaneously with EUS

This is another big advantage of the EUS test. If the doctor sees any suspicious lump or abnormal tissue during the test, a small sample of it can be taken for testing right away.

The tissue or fluid sample is then sent to a lab. A pathologist examines it and reports whether it contains anything abnormal, such as cancer cells.

How to prepare before the EUS test?

The doctor will give you clear instructions about what you should and shouldn't do before the test. They will usually say things like:

• Medications: If you are taking blood thinners or insulin for diabetes, your doctor will tell you how to adjust the dosage of those medications. Never stop taking your medication on your own.
• Food and Drink: You will be asked to stop eating and drinking for a few hours before the test. Usually about 6-8 hours. This will empty your stomach and allow the test to be clear.
• Bowel cleansing: If you are having a lower EUS, your doctor will give you a special medicine (bowel prep) to thoroughly cleanse your intestines. This should be used exactly as directed.
• Driver: This test is done to put you into a light sleep, so you won't be able to drive after the test. So you'll need someone to take you home.

What happens during the test?

This is usually an outpatient procedure that can be done without a hospital stay. The entire procedure takes about 60 minutes.

How to perform Upper EUS (oral):

You will be turned to your left side and made to lie down on the bed. Then,

1. You will be given a sedative intravenously to help you relax and fall asleep.

2. Spray a medicine to relieve a sore throat.

3. A plastic mouthguard will be placed in your mouth to prevent damage to your teeth and to prevent you from chewing on the endoscope.

4. The doctor then very carefully inserts the endoscope through the mouth and passes it down the esophagus into the stomach and the first part of the small intestine (duodenum).

5. You will not feel any pain at this time. You can breathe normally.

6. The doctor looks at the monitor and examines the internal organs and lumps.

7. If necessary, a biopsy (a piece of tissue) will be taken as mentioned earlier.

8. When the test is over, the doctor will remove the tube and stop the anesthesia you were given. You will wake up in a recovery room.

How to perform a Lower EUS (per rectum):

This is the same as above. You are turned onto your left side and made to lie down, and you are put into a light sleep. Then,

1. The doctor inserts the endoscope through the anus and passes it up the large intestine.

2. You will not feel any pain or discomfort during this procedure. You will be able to breathe normally.

3. The lower digestive system and surrounding organs are examined by looking at the monitor.

4. When the test is complete, the tube is removed and the anesthesia is stopped.

What happens after the EUS test?

The sleeping pill you were given will wear off within 30-60 minutes. After that, you may feel some minor discomfort.

• After the Lower EUS: You may feel a feeling of fullness (gas) and slight stomach cramps.
• After the Upper EUS: You may feel a slight soreness in your throat.

Are there any risks involved?

EUS is a very safe procedure, but as with any medical procedure, there are some complications that can occur very rarely.

• Allergic reaction to anesthetics.
• Damage or bleeding in the digestive system.
• During an upper abdominal examination, fluid from the mouth or stomach may enter the lungs (lung aspiration).
• If a biopsy is taken, inflammation of the pancreas (pancreatitis) may occur.
• A hole in the intestinal wall (perforation).

These things happen very rarely. Your doctor will take every step to minimize these risks.

When do you need to talk to the doctor?

If you experience any unusual symptoms after your test, you should call your doctor immediately.

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