Endoscopic ultrasound service (EUS)

Endoscopic ultrasound service or EUS is a type of endoscopic investigation. A flexible tube is inserted into your digestive tract via the mouth (upper EUS) or anus (lower EUS).

Whereas a conventional endoscopy uses light to see the inside of the digestive tube, EUS uses high frequency sound waves to create high resolution images of the wall of the gut, nearby organs, and other nearby structures. Under ultrasound guidance, tissue samples can be taken to help obtain a diagnosis (fine needle aspiration or biopsy).

EUS is generally performed under sedation as an outpatient procedure.

When is EUS offered?

Assessing the pancreas

• Assessing and samplings masses
• Diagnosis and surveillance of cysts
• Investigating the cause of recurrent pancreatitis
• Diagnosing chronic pancreatitis and autoimmune pancreatitis
• Investigating a dilated pancreatic duct.

Assessing bile ducts and gall bladder

• Assessing the cause of abnormal liver tests, a dilated bile duct, and/or pain when other imaging is inconclusive
• Assessing and sampling a narrowing or mass
• Differentiating between gall stone disease and functional biliary disease.

Assessing lumps and bumps in the wall of the upper and lower digestive tract 

• This can include biopsies.

Assessing lumps and bumps in organs and lymph nodes near the upper or lower digestive tract

• This can be within the chest, upper abdomen or lower abdomen, and may include lymph nodes, liver, adrenals glands or organs mentioned above and may often involve a biopsy.

To offer minimally invasive therapy

• Inflammatory collections around the upper or lower digestive tract can be drained internally by EUS, often without the need for surgery or external drains
• The most common example is drainage of collections related to the pancreas.

EUS is also used for diagnosing unexplained pain, especially when a pancreas, bile duct or gall bladder cause may be possible and staging known cancer.

What are the advantages of EUS?

EUS gives high definition images of the pancreas and bile ducts that means a diagnosis is often possible when an ultrasound, CT, or MRI weren’t able to assist in a diagnosis.

EUS guided biopsy can be important in establishing a diagnosis before surgery or to avoid surgery, and often helps guide other treatment decisions.

EUS can be combined with gastroscopy and allow complete examination of the digestive tract and surrounding structures in one procedure.  And minimally invasive procedures can be done without a hospital stay.

How is my EUS arranged at Northern Beaches Hospital?

If your GP, specialist or surgeon decides that you would benefit from an EUS they can make a referral to Dr Mathew Keegan or Dr Jo Collins at Peninsula Gastroenterology e: reception@peninsulagastro.com.au t: (02) 9997 2164

If you have any of the issues outlined above and are unsure if EUS may benefit you, you should explore this with your treating doctor or ask for a referral to discuss.

In some cases, an open access EUS can be arranged, this means that your procedure can be fast tracked without the need to wait for a consultation beforehand.

Planning for an EUS

Give your doctor a list of all the medications you are taking and any allergies you have.

• This should include both prescription and over-the-counter (OTC) drugs, like aspirin, NSAIDs or vitamins or supplements.
• Ask your doctor if any changes need to be made to these.

Tell your doctor if you:

• Have diabetes and what medications you have
• Are taking blood thinners or have bleeding or blood-clotting problems
• Have a pacemaker or other implanted electromedical devices
• Have had stomach or bowel surgery, swallowing problems or other gastrointestinal (GI) problems
• Have heart, lung or any other health problems that may need special care before the test.

Follow your doctor’s instructions about what and when you can eat or drink before your upper EUS.

Because of the medication given by the anaesthetist you will not be allowed to drive a car, work or make important decisions after the test. You must have a responsible adult to take you home and stay with you after the test.

In addition to this, if you are having a lower EUS you will need to take a bowel preparation. You need to ensure that you clearly understand what is required for this and that you have clear instructions on what to do.