I believe care must be customized
to each patient because the practice
of medicine is not a “one size fits all”.

William B. Evans, M.D.

Endoscopic Ultrasound (EUS)

Endoscopic ultrasound (EUS) is a medical procedure using an instrument that combines a tiny ultrasound unit on an upper endoscope (a lighted, flexible tube with a camera on its tip) to provide a visualization of your digestive tract. Uses as a diagnostic tool, EUS provides more information than other imaging tests of your digestive tract. Dr. Evans is a talented Louisville GI doctor, who perform EUS and has more specialized training than regular gastroenterologists, and therefore are uniquely qualified to perform this procedure both safely and effectively.

What is Involved in EUS?

To perform the EUS procedure, the physician passes an endoscope into the mouth to exam the upper digestive or gastrointestinal (GI) tract (esophagus, stomach and duodenum), or through the rectum to evaluate the lower GI tract (rectum and colon). Using a standard endoscope, the physician can view the inside surface of the GI tract.

The ultrasound unit administers sound waves that are transmitted into the body and are reflected by tissues and organs back into a sensor, which uses a computer system to make an electronic image on a video screen. Ultrasound technology is used in many other procedures as well; when a standard ultrasound probe is placed over the right upper abdomen, the liver can be examined. When it is placed to the right and left of the spine on the back, the kidneys can be seen. And ultrasound probes are used in pregnant women to examine the baby.

With EUS, the ultrasound probe is placed on the end of the endoscope. With the endoscope in the GI tract, other organs can be examined. The EUS scope is inserted into the mouth or rectum AFTER the patient is adequately sedated, so they will not feel ANY discomfort. The scope is positioned in the GI tract to evaluate the area of interest using the ultrasound probe to obtain pictures. In this way, the lining of the GI tract is better visualized as well as other organs near the GI tract, including the lungs, liver, gallbladder and pancreas.

An EUS is ordered to evaluate:

  • Known abnormalities (lumps, lesions) detected during previous endoscopy or on X-ray tests (CT scans, MRI)
  • Diseases of the pancreas, bile duct and gallbladder
  • Patients with cancer, in order to help determine the extent of spread of certain digestive (esophagus, stomach, rectum, ampulla) and respiratory cancers. EUS can determine the cancer’s depth and if it has spread to adjacent lymph nodes, major blood vessels or other organs
  • Causes of abdominal pain and weight loss

During the EUS procedure, a needle can be advanced, under direct visualization, into a lesion, mass, or lymph node to obtain tissue, which can help determine the proper treatment. This is called fine-needle aspiration (FNA).

EUS can also be performed for therapeutic indications to provide medication to areas, or allow drainage of the biliary system of fluid collections associated with the pancreas.

How Do You Prepare for the Procedure?

Prior to the EUS procedure, Dr. Evans will go over some pre-operative instructions that you will need to follow in the days before your procedure. Following these instructions is essential to limit surgery risks and provide the best results.

  • Stop certain medications. Dr. Evans and his staff will need to be made aware of all medications that you are taking, especially blood-thinning medications. These may include Coumadin (warfarin), Plavix (clopidogrel), Xarelto (rivaroxaban), Pradaxa (dabigatran), Eliquis (apixaban) and Lovenox (enoxaparin). Since the use of these medications increases the risk of excessive bleeding, they should be stopped prior to your procedure. If you are using insulin, the dosage or timing will also need to be adjusted the day of the procedure. Doctor-prescribed aspirin may be continued before your procedure. In addition, Dr. Evans asks that you provide him or his staff with a list of medications to which you are allergic.
  • Stop eating hours beforehand (for an upper GI tract exam). Refrain from eating anything starting the midnight before your procedure is scheduled.
  • Use our cleansing routine the day before (for a lower GI tract exam). Dr. Evans’ office will prescribe a cleansing routine (or “prep”), which consists of a powerful liquid laxative that is to be taken the day before the procedure in order to prepare your bowels. This cleansing routine is the MOST IMPORTANT part of the procedure. Dr. Evans’ office will give you further instructions on following this cleansing routine and other details to follow on the day before the procedure. These instructions include following a clear liquid diet the day before the procedure, and drinking lots of liquids.

Generally, antibiotics are not required before or after an EUS exam. However, Dr. Evans may prescribe a course of antibiotics after a specialized EUS procedure.

What Happens During an EUS Procedure?

EUS is usually performed as an outpatient procedure at Jewish Hospital. After you check in, you will be escorted to the “pre-op” area where an IV will be placed and nurses will take your medical information. You will then meet with an anesthesiologist to discuss the sedation for the procedure.

You will then be taken to a procedure room and connected to monitors to monitor your blood pressure, heart rate and blood oxygen levels throughout the course of the procedure. The procedure takes on average 20-40 minutes to complete.

What Should You Expect after the Procedure?

After the procedure, you will return to the “post-op” area to recover from sedation. During this time, you will be monitored for any potential complications from the procedure and/or sedation. Once you are fully recovered, Dr. Evans will provide you with an explanation of the findings from your procedure, along with a copy of the procedure report, patient information handouts and follow-up instructions. He will give you a full preliminary report at this time; however, it may take several days for the final results of biopsies.

Due to the effects of sedation, patients are instructed not to drive, operate machinery or make important decisions for the 24 hours following EUS. You will need to arrange for someone to drive you home after surgery. You will be able to eat after you leave the hospital, unless instructed otherwise. Some patients may have a temporary sore throat after the procedure. Over-the-counter anesthetic lozenges help soothe symptoms. The nursing staff will review these and other important post-op instructions with you prior to discharge.

Possible Complications and Risks

Although complications are rare when doctors, like Dr. Evans, who have specialized training and experience in performing EUS examinations, perform this procedure, complications do occur.

There is a small risk of bleeding, inflammation of the pancreas (pancreatitis) and infection (especially if FNA is performed). Another rare, but major, complication is a perforation, or a tear through the lining of the intestine, which may require surgery to repair.

Uncommon risks from sedation used for the EUS procedure are: reactions to sedation medications, possible aspiration of stomach contents into lungs and complications from heart and lung diseases.
All of these risks must be balanced against the potential benefits of the procedure and the risks of alternative approaches to the condition.

Disclaimer: This information is intended to provide general guidance and does not provide definitive medical advice. It is not a definitive basis for diagnosis or treatment in any particular case. This material does not cover all information and is not intended as a substitute for professional medical care. It is important that you consult your doctor regarding your specific condition, contraindications and potential complications.