Endoscopic ultrasound

Overview:

Endoscopic ultrasound (EUS) is a surgical procedure to detect any irregularities and diseases in the gastrointestinal tract and the surrounding organs. The method includes the use of a tube called the endoscope that is put into the digestive tract with an instrument that captures the sound waves to generate high-frequency and in-depth photos of the tissues of multiple organs.

The endoscope has a small ultrasound transducer or probe at one end. A needle is attached to the endoscope to pull out fluid and tissue samples for testing in the laboratory. This technique is called EUS-guided fine-needle biopsy. It can also be used to drain fluid from a lesion or inject medicine at a particular site.

Types Of Endoscopic Ultrasounds:

When the endoscope is put inside from the anus, the endoscopy is known as a lower endoscopy procedure. It checks the lower part of the digestive which includes organs such as: 

• The group of muscles surrounding the anus (Anal sphincter).

• Blood vessels and lymph nodes. 

• Cysts and tumors.

• The lining of the colon and rectum, which make up the large intestine.

In the upper endoscopy procedure, the upper part of the gastrointestinal tract is studied, and the endoscope is inserted through the mouth. The organs included are:

• The lining of the esophagus, lungs, stomach, and small intestine.

• Lymph nodes, blood vessels, cysts, and tumors.

• Pancreas, gallbladder, and bile ducts.

Applications of Endoscopic Ultrasound:

• The procedure can be used for the following:

• To understand the extent of damage to the tissues caused by inflammation or disease.

• To detect and provide detailed information about cancerous lesions and determine if the cancer has spread to the surrounding tissues, organs, or lymph nodes. The procedure also determines the extent of the spread.

• The technique helps to remove fluid from the tissue for lab testing.

• It can also help in extracting fluid from cysts

• It aids in delivering treatment to specific areas where tumors are detected.

The primary objective of the procedure is to produce clear and detailed images of the lining and interior portion of any organ or tissue that is a part of the digestive tract. The instrument is placed inside the throat to click pictures of the esophagus, stomach, and intestine. 

Endoscopic ultrasound can be used to investigate the following:

• Chest pain

• Pain in the abdomen

• Cancer

• Presence of any lumps or tumors detected by earlier scans.

• Digestive issues like inflammatory bowel disease, colon cancer, and fissures in the anus.

• Gallstones and cholecystitis (gallbladder inflammation).

• Lung cancer

• Cancer of the pancreas, pancreatic cysts, and pancreatitis.

• Barett’s esophagus, where swallowing becomes difficult.

The procedure:

How you prepare

• The doctor gives the person detailed instructions regarding preparation before the procedure.

• Fasting is needed six hours before the procedure begins, and the person must make sure that they undergo the procedure on an empty stomach.

• The doctor may ask the person to take blood-thinning medications.

• If the tube is inserted from the anus, a colon cleansing is needed which involves using laxatives and following of a liquid diet.

• It is important to let the doctor know if the person is taking any medications, or they have any health conditions. The doctor may ask the person to stop certain medicines before the procedure. 

• It is advisable to have someone accompany the person before the procedure as it requires the administration of anesthesia, and the patient may be drowsy and unable to travel alone back home.

During the procedure

• Anesthesia is administered, and the person is made unconscious to avoid pain and extreme discomfort. Some people are given sedatives before the procedure. However, they don’t feel pain as they are asleep.

• The patient is asked to lie down on their left side. The doctor puts a thin,flexible tube through the throat or the anus, depending on the objective of the procedure.

• The procedure is completed within an hour. 

• Some people may develop a sore throat if the endoscope has been inserted through the mouth, and the doctor may ask them to take lozenges.

After the procedure

A specialist pulmonologist or a gastroenterologist analyses the images. At the same time, a pathologist will study the biopsy and reveal the test results. Once the report is out, the doctor will discuss the results with the patient to discuss further treatment steps. The effect of the sedative goes away within half an hour to an hour. After the lower endoscopic procedure, the patient may experience gas, bloating, or cramps if air has been pushed inside the tract for a better view of the affected region. An upper endoscopic procedure may cause a sore throat. However, these symptoms go away within 24 hours after the test. The doctor may ask the person to rest for a day before resuming their daily activities. 

Risks Of Endoscopic Ultrasound:

• The patient has chances of developing an allergic reaction to the anesthesia used.

• There are chances of damage to the digestive tract, which can lead to bleeding.

• Some patients experience lung aspiration, which means that the liquid from the mouth or the stomach enters the lungs after the upper endoscopic procedure.

• Pancreatitis can develop after needle biopsy and upper endoscopic procedure.

• The intestinal wall may get damaged during the procedure and develop holes or perforations.

The doctor should be immediately contacted in the occurrence of the following symptoms:

• Presence of blood in the stools or dark stools.

• Significant pain and discomfort while passing stools.

• Fever and other signs of infections such as chills, etc.

• Difficulty while swallowing food.

• Feeling of nausea and vomiting.

• Blood in the vomit.

• Severe chest pain or pain in the abdomen that persists.

• Breathlessness

Conclusion:

An endoscopic ultrasound (EUS) is a safe and very effective non-invasive technique for doctors to check the inner portion of the digestive tract. Although the procedure comes with its challenges, it is a valuable and insightful way to diagnose complications and diseases of the digestive system and detect any irregularities in the tissue lining through various techniques. However, just like in all the procedures, the patient needs to be well-informed about the details and address all their concerns with their doctor before consenting to the procedure.

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