Endoscopic ultrasound (EUS) is a minimally invasive endoscopic technique which allows the doctor (endoscopist) to obtain detailed images of the pancreas. EUS provides the endoscopist with information additional to that obtained with CT or MRI imaging. It can be used to take needle biopsies from abnormal areas of the pancreas, avoiding exploratory surgery or can be used to take sample fluid from a pancreatic cyst.
A thin, flexible tube (endoscope) is passed through the mouth and into the stomach and duodenum. The tip of the endoscope contains a built in miniature ultrasound probe which emits sound waves. These sound waves pass through the lining of the stomach and duodenum creating a visual image of the pancreas and surrounding tissue. EUS can be used to obtain a needle biopsy of the pancreas or to sample fluid in a pancreatic cyst. This is done by passing a very thin needle from the endoscope into the pancreas under continuous ultrasound monitoring. This technique is called EUS-fine needle aspiration (EUS-FNA) and does not hurt.
EUS is performed in the Johns Hopkins Outpatient Building or in the 4th floor of the Blalock building. Procedures are performed either in the morning or afternoon. As you will be receiving intravenous (IV) sedation you will not be allowed to drive after the procedure. It is important that you have a companion (family member or friend) to take you home and plan to have someone stay with you at home after the examination as sedatives can affect your judgement and reflexes for up to twenty four hours.
EUS procedures are performed either in the morning or afternoon. If your procedure is schedule before 12 pm, do not eat or drink anything after midnight. If your procedure is scheduled after 12 pm you may have clear liquids until 8 am on the day of the test.
If you are taking medication for high blood pressure, seizures, or if you are taking prednisone, you may take these medications the morning of the procedure or at least two hours before the procedure with a sip of water. Do not take any water/fluid pills until after the completion of your procedure.
Anticoagulant medications (blood thinners such as warfarin (Coumadin), heparin, or clopidogrel (Plavix)) may need to be adjusted before the procedure. You should contact your prescribing physician for instruction on when to stop taking this medication. In general aspirin and non-steroidal anti-inflammatory medications (naproxen, ibuprofen etc) can be taken before an EUS examination.
More information, including instructions for patients who are diabetic, is available at http://www.hopkins-gi.org If you have any medical questions about the EUS, please call the nurse coordinator at (410) 502-0793 or the doctor performing the procedure.
The EUS procedure is performed using intravenous sedatives which help you relax. Depending on the sedation used, you may not remember the procedure. Most patients consider the procedure only slightly uncomfortable, while some fall asleep during it.
The actual procedure takes approximately 45-60 minutes. Most patients are discharged 3-4 hours after they arrive. Following the procedure, you will be monitored in the recovery area until the effects of the sedation have worn off. You will be able to eat after the procedure.
The procedure is usually performed as an outpatient. Most people are able to go home one to two hours after completion of the procedure.
Your endoscopist will usually be able to give you the preliminary results of the EUS on the same day as the procedure. If an EUS-FNA has been performed, these results take between five to seven days to return. If you attend the pancreatic cyst clinic, the EUS results will be reviewed along with any other imaging (CT or MRI) and pathology results at the weekly pancreatic cyst multidisciplinary meeting. During this meeting an individualised plan will be developed for you. You will be contacted by a member of the multidisciplinary team within twenty four hours of the meeting to discuss the plan with you.
EUS is a very safe procedure and although complications occur, they are rare when doctors with specialized training and experience perform the EUS examination. You may have a sore throat which usually resolves within a day or two. Sometimes people feel a little bloated due to the air inserted by the instrument. Other potential but uncommon complications of EUS include a reaction to the sedatives used, aspiration of stomach contents into your lungs, and complications affecting the heart or lungs. One major, but very uncommon complication of EUS is where there is a tear in the lining of the stomach or duodenum, called a perforation. This is very rare but can require surgery to repair the tear. If an EUS-FNA is performed, where a needle is passed into the pancreas to take a sample, there is a small risk of bleeding, pancreatitis or infection. To decrease the risk of infection, we routinely prescribe antibiotics for patients in whom EUS-FNA was performed on a pancreatic cyst.
If you have any other questions about your EUS procedure, please do not hesitate to contact the doctor performing the procedure.