Endoscopic Ultrasound (EUS)

What is endoscopic ultrasound?
Endoscopic ultrasound (EUS) is a procedure that uses sound waves to create visual images of the digestive tract, including the pancreas.

Why is EUS used?
The images created from an EUS procedure are detailed ultrasound pictures of the pancreas, bile duct and digestive tract.  An EUS allows a doctor to determine the size and location of a tumor in the pancreas and whether the tumor has spread to nearby lymph nodes or invaded nearby blood vessels or other structures.  During this procedure, a thin needle that does not cause pain can also be passed through the endoscope into the tumor to obtain tissue samples.  This is a type of biopsy called fine-needle aspiration, or FNA.  Cells obtained from the biopsy are examined with a microscope to see if they are cancerous.

What happens during an EUS?
During an EUS, the patient lies on his/her side while an endoscope (a thin, lighted tube) with a small ultrasound probe built into the tip is passed through the patient’s mouth the stomach and into the  top part of the small intestine called the duodenum.  The tube will not affect the patient’s ability to breathe normally.  Once in place, the ultrasound probe uses sound waves to create images of the pancreas and surrounding structures.

Usually, the EUS procedure lasts 15 to 45 minutes and is considered by most patients to be mildly uncomfortable.

What should I do to prepare for an EUS?
The healthcare team will give the patient exact instructions before an EUS procedure.  In general, the patient will not be allowed to eat or drink anything six hours before the examination.  Some patients receive antibiotics before the procedure to avoid infection.  The doctor will tell the patient whether to continue taking these or other medications before the EUS procedure.

EUS is performed under heavy conscious sedation so the patient may feel drowsy, but will be awake during the procedure.

Just before the EUS, the patient will receive sedative medication through a vein in the arm to help them relax and an anesthetic drug to block pain.  Since sedative medications are used, the patient should prepare in advance to have someone else drive him/her home after the procedure.

Image courtesy of Shawn Mallery, MD & Minnesota Pancreas and Liver Center

What can I expect after an EUS?
After the EUS procedure is completed, the patient will remain in the recovery room until the sedative medication has worn off.  The patient should not drive a vehicle after receiving sedative medication.  It is not unusual for the patient to experience a feeling of fullness or the need to pass gas after the procedure.  Also, the patient may have changes in bowel habits, for instance, soft stool, after the procedure.  The healthcare team will provide instructions regarding eating and drinking following an EUS procedure.

What complications can occur with an EUS?
Complications are very rare, but they include infection of a pancreatic cyst, pancreatitis, gastrointestinal bleeding, tearing from the endoscope, and reactions to anesthesia medications.  Overall, EUS is safer than another endoscopic procedure called ERCP.

How does EUS compare with other techniques used to image the pancreas?
EUS is one of the most common imaging procedures used to diagnose pancreatic cancer.  It is often the best procedure to obtain samples of a tumor to make a definitive diagnosis of pancreatic cancer.  EUS may be able to find small pancreatic masses that have not been detected by computed tomography (CT) or magnetic resonance imaging (MRI) scans but suspected by the doctor as a result of symptoms and/or blood test results.  Studies show that EUS is equal to or better than CT scans for detection of early pancreatic cancer.

The patient’s experience during an EUS procedure is similar to that of an endoscopic retrograde cholangiopancreatography (ERCP), but the images produced are different.  EUS is generally a safer test than ERCP.

Where would I go for an EUS procedure?
EUS is an outpatient procedure usually performed in a hospital endoscopy unit or ambulatory surgery center.  Patients do not have to stay overnight in the hospital.

New studies involving EUS:
Studies using EUS to screen people at higher risk for developing pancreatic cancer are underway.  EUS has the ability to detect early abnormal changes in the pancreas in these individuals.

Other Resources:
American Gastroenterological Association (AGA)
American Society of Gastrointestinal Endoscopy (ASGE)

For more information about jaundice, stents or other the other imaging tests mentioned above, contact a Patient and Liaison Services (PALS) Associate toll free at 877-272-6226 or email pals@pancan.org.  PALS Associates are available M-F 7am-5pm Pacific Time.

 

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