Overview

An endoscopic ultrasound (EUS) is a procedure that uses a flexible tube called an endoscope. The endoscope is put into your mouth, down your food pipe (oesophagus). It goes into your stomach and the first part of your small intestine.

An EUS has a camera and ultrasound probe. It can be used to take detailed pictures of your upper gastrointestinal tract and other organs.

An EUS can also be used for procedures. It has a channel inside it, allowing doctors to use instruments to take tissue samples or treat infections.

These procedures are known as EUS-guided procedures. They can be used to treat:

• an infected gallbladder
• a blocked bile duct into the stomach (trans-gastric) or the small bowel (trans-duodenal)

Having an EUS for these conditions means you do not need tubes through the skin and tummy (abdominal) wall, which can have some risks.

An infected gallbladder

Draining an infected gallbladder with an endoscope is a procedure called a cholecystoduodenostomy. This procedure is for people who have infections of their gallbladder with pus, mainly due to gallstones. These infections can be serious, and can sometimes be fatal

A metal stent is put into the gallbladder during an EUS. This allows the infection to drain into your stomach or small bowel.

It also allows your doctor to look at the inside of your gallbladder, to clear the infection, or clear any gallstones.

People with an infection can have surgery to remove their gallbladder. However, surgery can be a risk for some people due to other factors (such as age, heart conditions or breathing problems). 

In people who cannot have surgery, a cholecystoduodenostomy lets the doctor drain the infection with an endoscope. This reduces the risks of surgery.

A blocked bile duct

A blocked bile duct can cause jaundice. This causes yellow skin and eyes, and itchy skin.

EUS-guided drainage lets the doctor drain the blocked bile duct with an endoscope. A metal or plastic stent is put into the bile duct so the bile can drain into your stomach or small bowel.

This can help people who are jaundiced, and relieve their symptoms and any pain from the blocked bile duct.

People with a blocked bile duct can have endoscopic retrograde cholangiopancreatography (ERCP) to drain the bile. However, an ERCP can be a risk for some people, as it needs drains put in through the skin or abdominal wall.

Preparing for your procedure

It is important that you do not eat or drink any solid food for 6 hours before your procedure. This is so the doctor has a clear view with the camera. You can drink only water up to 3 hours before.

You will have blood tests to check the clotting of your blood and your blood count.

If you are having sedation or a general anaesthetic, and are going home within 24 hours, you must have someone to take you home and stay with you overnight. They must be over 18 years old. They should come with you for the appointment, or be contactable by phone when you are ready to leave.

If you do not have someone to take you home and stay with you overnight, your procedure might be cancelled. If you cannot arrange for someone to collect you, please contact us to discuss alternative arrangements.

Your medicines

You will have a chance to talk about any medicines you take with a doctor or nurse before your procedure.

• Tell your doctor or nurse if you are taking antiplatelet or anticoagulant medicines to thin your blood or to prevent blood clots (such as, aspirin or clopidogrel, warfarin, rivaroxiban or dabigatran). You will need to stop taking these medicines for a short time before your procedure. Your endoscopy team might give you different medicines to take during this time.
• Tell your doctor or nurse if you are taking sedatives, chronic pain medicines, or medicines for diabetes.
• You should keep taking all your medicines as usual, unless you have been told otherwise by the doctor or endoscopy nurse.

If you have any questions about any of your medicines, please talk to your GP.

What to bring with you

Do not bring any expensive items to hospital (such as electronic devices), as the hospital will not accept responsibility for them if they are lost. 

You need to take off all your jewellery (except wedding rings) before the procedure. This is because metal can make X-rays unclear. 

You might want to bring your dressing gown and slippers with you (we do supply non-slip socks).

Giving your permission (consent)

We want to involve you in decisions about your care and treatment. If you decide to go ahead, you will be asked to sign a consent form. This states that you agree to have the treatment and you understand what it involves.

If you would like more information about our consent process, please speak to a member of staff caring for you.

When you arrive at the endoscopy unit

If you are on a ward, a porter will collect you when it is time for your procedure and take you to the department.

When you arrive, please give your name to the receptionist. We'll ask you to wait in the waiting area until you are seen by an endoscopy nurse.

The nurse will ask you about your medical history. Tell the nurse if you have had any reactions or allergies to other procedures or medicine in the past.

When you are ready, you will be taken to the second waiting area, signposted ‘sub wait area.’ Your endoscopist will explain more about the procedure and answer any questions you have.

You will be asked to undress and put on a hospital gown and disposable underwear. Please remove your jewellery, and any false teeth.

Waiting times

Our endoscopy teams run up to 5 procedure rooms at the same time. This means that a person who arrived after you might be called in before you are. This does not mean you have been forgotten, but that the other person is on a different list than you.

We do everything we can to avoid you waiting any longer than necessary. However, because every procedure takes a different length of time, sometimes it is hard to give exact timings.

We will update you on how long you are likely to be with us.

Please be prepared to be with us for a few hours.

During the EUS-guided procedure

You will usually be given an antibiotic 1 hour before your procedure. You can swallow this with a small amount of water. People who are in the hospital will already be on antibiotic treatment.

The procedure will take between 30 to 60 minutes.

A nurse will do your observations (pulse, oxygen level, blood pressure and heart rhythm).

We give you an anaesthetic throat spray to numb your throat.

We ask you to lie on your side, and a mouth guard will be placed in your mouth to protect your teeth and the camera. Oxygen will be given to you throughout the procedure.

We give an injection of sedation and a painkiller through a small tube (cannula) in your arm or the back of your hand. This will relax you and make you sleepy, but will not put you to sleep.

You can hear what is said to you and respond to any instructions given to you. A nurse will sit by your head and monitor you for the whole procedure.

Some people might be given a general anaesthetic to put them to sleep completely. This will depend on the procedure and other medical conditions you have. 

Once you are sleepy, a flexible tube (endoscope) will be passed through your mouth, and into your stomach or the first part of your small intestine. A technique called diathermy (electrical heating) will be used to make a small hole. The stent is placed through this hole into the gall bladder or bile duct. Sometimes, we need to widen the stent to allow better drainage.

Samples might be taken to be tested in a laboratory. This is to check that the right antibiotics are being used to treat your infection.

Anaesthetic during the procedure

You will have sedation during the procedure, or general anaesthetic in some cases. 

You will also be given a painkiller before and during your procedure, to make you as comfortable as possible.

If you have sedation, you might have cramps and tummy (abdominal) pain during or after the procedure. This is from the air that we use to inflate your small intestine.

We will give you pain medicine in your bottom (a suppository) before the end of the procedure. This will also reduce the risk of infection.

After the procedure, you can take painkillers such as paracetamol.

Having peppermint (as peppermint tea or peppermint water) can help to pass the air.

If you have severe tummy (abdominal) pain, tell your nurse straight away. If you are at home, contact your GP or go to the emergency department (A&E)

After your procedure

The nurse will take you to the recovery area. They check your observations regularly, and monitor you for any complications. We will transfer you back to the ward if your observations are stable.

Once you are awake, you can have something to drink. You will need to have a liquid diet for 24 hours after the procedure.

You might need antibiotics for at least 5 days after the procedure, or for longer if an infection takes longer to settle.

Your results

Your doctor or nurse will talk you through the results of the procedure, but you might be sleepy and not be able to remember the details.

These results will be available to the doctor on the ward, and they can explain them to you.

After you leave hospital

If you are staying overnight on the ward, you will be given instructions when you leave hospital.

If you had sedation or a general anaesthetic and are going home within 24 hours, you must have someone to take you home and stay with you overnight. Please make sure you follow our instructions to stay safe.

You will need to follow specific instructions about eating and drinking after your procedure, which you will be given on the day of your procedure.

If you develop any signs of infection, you will need a repeat procedure to check if the stent is blocked. If it is, it might need clearing.

Removing your stent

Depending on why the procedure was done, the stent will be removed after 4 to 6 weeks, or left in place permanently.

Risks of EUS-guided procedures

This procedure is generally safe, but there can sometimes be complications.

Your doctor will talk about all the risks with you and your family members in detail before the procedure.

Although there are some risks, you will only have this treatment if your doctor believes the possible risks of doing the procedure are better than doing another procedure, or doing nothing.

Possible minor complications

• Mild discomfort in the tummy (abdomen), which might last for a few days.
• A sore throat, which might last for a few days.
• Loose teeth, crowns and bridgework can move or fall out when the endoscope is put into your mouth. This does not happen often.
• You might have a sore lump for a few days. This is due to irritation of the vein where medicine was given for the procedure. This is not common.
• In some cases, the procedure cannot be completed due to other problems.

Possible serious complications

• Some infections that are ongoing might need prolonged antibiotics, or a repeat procedure to remove the infection.
• Very frail or elderly people can get pneumonia (swelling of the lung tissue) after the procedure. This is due to stomach juices getting into the lung. This happens in about 1 in 500 cases.
• A hole (perforation) might be made in the wall of the oesophagus, stomach or small intestine by the instruments used in the procedure. This might need surgery to treat it, and can occasionally be fatal.
• There is a risk of bleeding from the wall of the oesophagus, stomach or small intestine due to the instruments used in the procedure. This usually stops on its own. If it does not stop, your doctor might have to stop the bleeding through the endoscope. In severe cases, a blood transfusion, a special X-ray procedure or an operation might be needed to control the bleeding.
• A hole is made through the small intestine to get to the gall bladder. Sometimes, this can cause some of the stomach juices, or bile, to leak into the abdominal cavity. This can cause an infection called peritonitis. If this happens, you will have antibiotics to treat the infection. Some people need surgery. This can be serious, and occasionally be fatal.

Other treatment options

• Do nothing, have no treatment.
• Have drains through the skin (per-cutaneous drainage) using X-ray-guidance. This means there is an drain outside of your body, which can carry a risk of infection or the drain moving.
• Have EUS-guided drainage surgically. This is more invasive, and has more risks. Some people are not suitable for this surgery.