Endoscopic Ultrasound - A Complete Overview

Introduction:

Endoscopic ultrasound is a readily available therapeutic and diagnostic tool used worldwide. They combine both techniques of visualizing internal organs by the endoscope and using ultrasound to emit high-frequency sound waves, thereby allowing proper imaging of the internal organs. Not only does this procedure diagnose conditions, but this cost-effective procedure also plays a significant role in managing cancer patients by accurately staging cancer.

What Is an Endoscopic Ultrasound?

Endoscopic ultrasound is a procedure done by a gastroenterologist (digestive tract specialist) to examine the inside portions of the digestive tract. Endoscopic ultrasound uses both endoscope and an ultrasound. A regular endoscope is a long thin tube attached to a camera with its end containing light. Endoscopic ultrasound uses a special endoscope that has an ultrasound probe at the endoscope end. This scope bends well and moves efficiently around the areas of the digestive tract. It then transmits sound waves to produce pictures of the internal organs. Air can also be blown through the scope, expanding tissue folds for better examination of the tissue lining.

In Which Conditions Is an Endoscopic Ultrasound Suggested?

Endoscopic ultrasound diagnoses or evaluates conditions such as:

• Chest pain or abdominal pain.

• Conditions in the digestive tract like inflammatory bowel disease, anal fissure (tear in the anus), or colon cancer.

• Diseases in the gallbladder like gallstones or gallbladder inflammation (cholecystitis).

• Diseases of the lung like lung cancer.

• Diseases of the pancreas like pancreatitis, pancreatic cysts, and pancreatic cancer.

• Swallowing disorders like Barrett's esophagus. Barrett's esophagus is a precancerous condition in which the esophagus gets damaged.

• If abnormal tissue growths like cysts or tumors are seen in previous scans like magnetic resonance imaging (MRI) or computed tomography (CT).

• Metastasis of cancer (spread of cancer to other organs).

What Are the Types of Endoscopic Ultrasounds?

Endoscopic ultrasound can be an upper endoscopy procedure or a lower endoscopy procedure:

• Upper Endoscopy Procedure - Upper gastrointestinal (GI) endoscopy examines the upper digestive tract. This includes lymph nodes, cysts, tumors, blood vessels, nearby organs like the gallbladder, bile duct, pancreas, linings of the stomach, small intestine, and esophagus. The entry point of an upper endoscopic procedure is the mouth.

• Lower Endoscopy Procedure - A lower GI endoscopic procedure examines the lower digestive tract. This includes the muscles surrounding the anus, lymph nodes, blood vessels, tumors, and the rectum and colon linings. The entry point of a lower endoscopy procedure is the anus.

What Are the Instructions for Patients Before an Endoscopic Ultrasound Procedure?

Before an endoscopic ultrasound is performed, the doctor will explain what should and should not be done. Some of the steps are listed below:

• If the patient takes medications like blood thinners or insulin, the doctor will adjust the dose of medications like insulin or blood thinners. Sometimes, the patient will be asked to hold off on the blood thinning medications until the procedure is performed.

• The patient will be requested not to drink or eat for a specific time before the test and not to drink alcohol or take drugs before the procedure.

• A prescription bowel prep is done to clean the bowels if a lower endoscopy procedure is performed. This is also called colon cleansing.

• The patient will be asked to bring another person along with them during the procedure day to drive them home after the procedure.

What Happens During an Upper Endoscopic Ultrasound?

• An upper GI endoscopic ultrasound is an outpatient procedure that takes about 60 minutes. The patient can go home the same day.

• Patients will be asked to lie on their left side.

• The procedure can be slightly uncomfortable, so the doctor gives intravenous sedation to help the patient relax.

• An anesthetic medicine (numbing medicine) will be sprayed on the patient's throat.

• A plastic mouth guard will then be placed in the patient's mouth. This mouth guard will protect the patient's teeth and prevents the patient from biting down the endoscope.

• The ultrasound endoscope is inserted through the mouth into the esophagus and stomach until it reaches the small intestine's upper portion (duodenum).

• The insertion of the endoscope does not cause any pain, and the patient can breathe normally without facing any difficulties.

• The endoscopic ultrasound will produce images that are transmitted to the monitor.

• The doctor checks the images formed on the monitor.

• In some cases, during the procedure, if the doctor finds something unusual, a biopsy might be performed. A thin needle is threaded through the endoscope to take tissue samples or fluid.

• The endoscope is then gently removed. The patient will wake up in the recovery room when the anesthesia wears off.

What Happens During a Lower Endoscopic Ultrasound?

• A lower GI endoscopic ultrasound is also an outpatient procedure, and the patient can leave home on the same procedural day.

• During a lower GI endoscopic ultrasound, the patient will first be asked to lie on their left side.

• The doctor will then give an intravenous sedative.

• The endoscope is inserted through the anal region and rectum into the large intestine.

• The images taken by the ultrasound are then examined for any abnormalities.

• After obtaining images, the endoscope is removed gently. The patient will wake up once the anesthesia wears off.

What Happens After an Endoscopic Ultrasound Procedure?

• After the endoscopic ultrasound, the sedation will wear off within 30 minutes or an hour of the procedure.

• The patient might experience bloating, gas, or slight abdominal cramps after a lower endoscopic ultrasound.

• Symptoms like sore throat can happen after an upper endoscopic ultrasound.

• After an endoscopic ultrasound, the doctor will review its findings with the patient on the same day.

• The doctor will recommend further treatment options if any abnormality is detected from the procedure.

• If a biopsy (removal of small tissue to check under a microscope) is performed during the ultrasound, the patient will usually obtain their results after one week.

What Are the Risks Associated With an Endoscopic Ultrasound?

Endoscopic ultrasound is a fairly safe procedure. However, certain complications can occur like perforations to the intestine, infection to the bowels, pancreatitis (inflammation of the pancreas), which might occur after an upper endoscopic ultrasound or needle biopsy, damage to the digestive tract, an allergic reaction to anesthesia, and sometimes fluid from the mouth or the stomach might enter the lungs after an upper endoscopic ultrasound.

What Are the Side Effects Associated With an Endoscopic Ultrasound?

Side effects after an endoscopic ultrasound are usually rare. However, certain symptoms to be looked for include fever (a sign of an infection), nausea or vomiting, blood while vomiting, difficulty swallowing, pain during bowel movements, blood in the stool, shortness of breath, severe chest or neck pain, or abdominal pain. If a patient experiences any of these symptoms, they must report to their respective doctors and undergo an evaluation.

Conclusion

Endoscopic ultrasound is a non-invasive, safe, and effective outpatient procedure performed by specialists to examine the inside regions of the digestive tract. Endoscopic ultrasound scans can be of two types; an upper GI endoscopic ultrasound and a lower GI ultrasound. These procedures help diagnose various conditions of the digestive tract, lungs, pancreas, and various cancers in these regions.