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Endoscopic ultrasound combines endoscopy and ultrasound in a single instrument: an endoscope with an ultrasound probe at its tip is passed through the mouth into the oesophagus, stomach and duodenum, imaging the layered wall of the digestive tract and the organs lying against it from the inside. Because the probe sits directly against the target, with no bone, gas or fat in between, it provides finer detail than ultrasound performed through the abdominal wall. Its commonest uses are assessment of the pancreas, including a mass, a cyst, chronic inflammation or a small stone that is hard to see otherwise; examination of the bile duct when a stone is suspected but was not visible on standard ultrasound; characterisation of a submucosal mass in the stomach wall; staging the local extent of a tumour of the oesophagus, stomach or rectum together with the surrounding lymph nodes; and imaging of the left lobe of the liver and the left adrenal gland. For this reason it is often the study that settles or averts a decision to operate. Its second strength is that it acts as well as images. A fine needle can be passed through the scope under ultrasound guidance to sample a mass, a lymph node or a cyst, known as fine-needle aspiration or biopsy. Fluid collections around the pancreas can be drained, and in selected patients a nerve plexus can be injected to relieve chronic pain. The limits should be clear: endoscopic ultrasound does not deliver treatment inside the bile ducts, which is the role of ERCP; it does not examine the colon; it sees only the beginning of the small bowel; and it cannot determine the nature of every mass without tissue. Its yield depends heavily on operator experience and on a clean stomach, and a negative result from a single sample does not always exclude disease and may need repeating. It does not replace MRI or CT but complements them. Whether and when to perform the study is decided by clinical assessment and previous imaging, not by reading about it. Because deep sedation is usually used, you need an escort and must not drive afterwards. Complications are uncommon but should be named honestly: bleeding, infection, pancreatitis after sampling of the pancreas, and perforation.
Your previous ultrasound, CT or MRI and your laboratory results are reviewed and the exact target for imaging or sampling is defined, because this is a targeted study rather than a general survey of the abdomen.
You fast from food and fluids for the stated period, because an empty stomach is required both for good images and for airway safety. Deep sedation or general anaesthesia is then given, with pulse, oxygen and blood pressure monitored throughout.
The scope is advanced and the ultrasound probe is positioned against the target, imaging the layers of the gut wall together with the pancreas, bile duct and adjacent lymph nodes, with measurements taken and images recorded.
If sampling is indicated, a fine needle is passed through the wall of the stomach or duodenum into the target under direct ultrasound vision, and tissue or fluid is aspirated and sent for histology or analysis.
You are monitored until sedation wears off and any pain or fever is noted, then a report of the findings and measurements is issued. The result and the sample then guide the decision: surveillance, therapeutic ERCP, surgery, or a tumour treatment plan.
Fasting from food and fluids for the period the unit specifies is mandatory, because the procedure is performed under deep sedation or general anaesthesia, and a full stomach both degrades the images and increases the risk of aspiration. Tell your doctor about all your medications, particularly blood thinners and anticoagulants, since needle sampling requires special arrangements and clotting tests may be needed, and also your diabetes medicines. Report any drug allergy, heart or lung disease, a heart valve or pacemaker, and any previous surgery on the stomach or oesophagus, and mention pregnancy. Bring your earlier ultrasound, CT, MRI reports and laboratory results, because they change and direct the course of the examination toward the target. Remove dentures before entering the room. Arrange an adult escort to take you home and stay with you, as driving is not permitted on the day of sedation.
Drowsiness, bloating and a scratchy throat are usual for a while. Do not eat or drink until the team allows it and full throat sensation has returned, then start with lukewarm fluids and light food. Seek emergency care immediately for severe upper abdominal pain radiating to the back with vomiting, the key sign of pancreatitis after sampling of the pancreas, or for fever and chills, vomiting blood or black tarry stools, chest pain or breathlessness, a distended or rigid abdomen, or dizziness and fainting. These indicate the rare complications of pancreatitis, bleeding, infection and perforation, all of which are managed best when caught early, so do not wait for morning. Do not drive, operate machinery or sign important documents on the day of sedation, and do not spend that night alone. Restart blood thinners on the date your doctor specifies. Return for your sample result, because the decision about surveillance, ERCP or surgery rests on it rather than on how well you feel.
Usually 30 to 60 minutes, a little longer when a sample is taken, plus one to two hours of recovery and observation before discharge.
Dr Mohammad Mahmoud Rashid is a consultant in gastroenterology, hepatology and endoscopy with British postgraduate qualifications. His clinical work covers live…
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