Endoscopic ultrasound of upper gastrointestinal tract

What you need to know before the examination?

Endoscopic ultrasound (EUS) of the upper gastrointestinal tract is an examination that combines endoscopy and ultrasound examination of the wall of the digestive organs and the surrounding area. The pancreas, bile ducts and gallbladder can be examined closely. The examination is performed to identify submucosal lesions detected by endoscopic examination (gastroscopy), to define the depth of certain lesions, so that we can decide on the method of removal. It is the best examination for suspected bile duct stones, and a detailed examination of the pancreas, bile ducts and gallbladder is possible. 

It is similar to a gastroscopy, but takes longer, so it is performed under analgosedation. You should be fasting before examination, which means you should not eat for 6–8 hours before the examination. The last meal should be light, preferably a cooked, easily digestible, low-fat meal the evening before the examination. You can drink water on the day of the examination, but you should not consume anything for the last three hours. 

Bring detailed information about medications, allergies, previous treatments with you to the examination. Bring the results of previous examinations based on which you were referred for endoscopic ultrasound. 

More about examination

An echoendoscope is a thin, flexible endoscope with an ultrasound probe and camera at the tip, allowing ultrasound to be used to examine the wall of a specific part of the gastrointestinal tract and the surrounding area, and to directly examine the inside of the gastrointestinal tract. 

The examination allows the layers of the oesophageal, gastric and duodenal wall to be examined and the extent and depth of the lesions to be determined. It is mainly used to identify submucosal lesions in the upper gastrointestinal tract wall, which are mostly benign. In some cases, it is needed to assess polyps before deciding on the method of removal, and to assess the stage of tumours in certain cases. 

Endoscopic ultrasound is the most accurate examination for examining the bile ducts and gallbladder, in case of suspected bile duct stones also blockages and narrowings. It allows a detailed examination of the pancreas with similar accuracy to an MRI scan. 

Course and duration of examination

We take vital signs measurements upon arrival and set up an intravenous line in an arm vein to administer medication. Discuss with your doctor the reasons for the examination, your general health, chronic illnesses, any hospitalisations, surgeries and previous anaesthetics, allergies, bad habits and other risks. You can ask your doctor if you need further clarification or explanation. 

The examination is performed in a lying position on the left side. The throat is numbed with a local anaesthetic before the examination, and you receive sedatives and painkillers into the vein. You can breathe normally through your nose or mouth during the examination. 

The doctor carefully examines the pancreas, gallbladder, bile ducts, the wall of each part of the upper gastrointestinal tract according to the clinical issue. 

The examination usually takes 20–30 minutes. 

Analgosedation requires rest and medical supervision for half to 1 hour after the procedure. You discuss the findings and results with your doctor before discharge. You receive instructions on what to do next and the result of the examination. 

Risks, side effects, possible complications

You may feel a slight discomfort in your throat after the examination. The procedure is safe and there is a low risk of complications, which we have never experienced before. There may be mild side effects due to analgosedation, which can be prevented by resting immediately after the test and following any instructions given to you by the medical staff upon discharge.