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Endoscopic Ultrasound (EUS)

Overview

Endoscopic Ultrasound (EUS) is an imaging technique that combines endoscopy and ultrasound technology. It is performed to get detailed images of the digestive organs including the pancreas, liver and also the surrounding parts like lymph nodes. The procedure involves inserting a flexible tube called endoscope equipped with an ultrasound probe at its tip. The ultrasound waves create high-resolution images, allowing for a thorough examination of soft tissues and structures that may not be visible on other imaging tests.

EUS is widely used for diagnosing and managing a variety of medical conditions. Your doctor may recommend an EUS for the following cases:

  • Cancer Detection: It is crucial for detecting and staging cancers of the pancreas, bile ducts, and other nearby organs.
  • Pancreatic Disorders: In case you are suffering from a pancreatic disorder, EUS may help in diagnosing the underlying causes such as pancreatitis, cysts or pancreatic tumours.
  • Bile Duct and Gallbladder Issues: It helps detect blockages, stones, and growths in the bile ducts and gallbladder.
  • Liver and Lymph Node Evaluation: EUS can assess abnormalities in the liver and help evaluate enlarged or suspicious lymph nodes.
  • Biopsy: Biopsies involve collection of tissue samples from suspicious areas for further analysis. If required, EUS can be used for fine-needle aspiration (FNA) biopsies.

Before undergoing EUS, patients typically need to avoid eating or drinking for at least 6 hours before the procedure. Some medications, particularly blood thinners, may need to be paused, so it is important to discuss any ongoing treatments with your doctor.

The procedure is generally performed in an outpatient setting, and it follows these steps:

  • The patient receives a sedative to ensure comfort during the procedure.
  • Once the patient is sedated, the doctor gently inserts the endoscope either through the mouth (for upper GI tract) or rectum (for lower GI tract), depending on the area being examined.
  • The ultrasound probe on the endoscope emits sound waves that generate detailed images of the organs.
  • If a suspicious area is found, a fine needle is used to obtain tissue samples for analysis.
  • The procedure usually lasts between 30 to 60 minutes. However, in case there are any complexities, it may take longer.

EUS provides several significant advantages for both diagnosis and treatment:

  • High-Resolution Imaging: It delivers clear images of soft tissues, making it a valuable tool for assessing conditions that might not be visible with CT or MRI.
  • Early Detection: EUS can detect cancers in the pancreas, liver, and bile ducts at early stages, which is essential for successful treatment outcomes.
  • Minimally Invasive: Since biopsies can be performed during the procedure, EUS avoids the need for more invasive surgeries.
  • Accurate Staging: The procedure helps determine the stage of cancer or other diseases, which is critical for planning treatment.
  • Real-Time Monitoring: The ability to monitor areas in real-time aids in the timely identification of any changes that could indicate progression or improvement.

While EUS is a powerful diagnostic tool, there are alternative procedures that might be used depending on the patient's condition:

  • CT Scan: A computed tomography (CT) scan offers detailed images of the abdomen and can help detect tumours, but it is less effective than EUS for assessing soft tissue.
  • MRI: Magnetic resonance imaging (MRI) provides clear images of soft tissues and can be an alternative for evaluating certain conditions, particularly liver abnormalities.
  • Endoscopic Retrograde Cholangiopancreatography (ERCP): This procedure uses an endoscope to inject dye into the bile ducts, allowing for X-ray imaging of the biliary system. It is especially useful for detecting bile duct blockages and for performing procedures like stone removal.
  • Ultrasound: Traditional ultrasound, often used for liver or gallbladder evaluations, can detect structural changes but lacks the detail provided by EUS.

Although EUS is generally considered safe, there are some risks to be aware of:

  • Discomfort: Some patients may experience mild discomfort during the insertion of the endoscope.
  • Bleeding: Minor bleeding can occur, especially if a biopsy is taken, but this usually resolves without issue.
  • Infection: There is a slight risk of infection at the biopsy site, although this is rare.
  • Perforation: Though uncommon, there is a very small chance of puncturing the digestive tract, requiring additional treatment
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