A GI tract endoscopic ultrasound scan (EUS) is a test using a specially modified endoscope to examine the gastrointestinal tract from inside outwards. An ultrasound probe is attached to the end. This allows the doctor to get detailed pictures of internal organs and structures around the gut.
Because the special endoscope has an ultrasound probe built in, it can generate pictures of the structures surrounding the gut rather than just seeing the inner lining of the stomach itself, which is what standard endoscopy does.
It is particularly useful to assess tumours arising in the oesophagus and enlarged lymph glands nearby. Indeed for local staging of oesophageal cancer, it is considered the test of choice. It is also possible to assess the pancreas gland, liver, gallbladder and stomach.
Although EUS can be used to look at abnormalities in the gall bladder and pancreas, in our practice, as oesophageal specialists, we only offer it currently to look for abnormalities in the oesophagus and stomach.
Our main focus is on assessing tumours in the oesophagus and stomach to inform surgeons as to whether surgery is appropriate and safe. Usually this is done by measuring the precise size and position of the growth. Sometimes we will also remove a small sample to send to the laboratory for analysis.
Endoscopic ultrasound preparation is the same as a standard endoscopy (gastroscopy). This means fasting for 6 hours before the endoscopic ultrasound procedure. No other special preparation is usually needed.
You will usually be sedated for the endoscopic ultrasound procedure so you should have someone to take you home from the hospital and stay with you until the next day.
A standard gastroscopy is done first to identify the landmarks from within the oesophagus and stomach. The gastroscope is removed and the EUS endoscope is then inserted. This is the same size or slightly larger than a standard endoscope. It is also a flexible telescope with a thickness similar to a little finger.
As well as the light and tiny video camera that is found on normal endoscopes, the EUS scope also has within its tip an ultrasound probe. This allows the doctor to see through the layers of the bowel wall into structures surrounding it. The endoscope also has a ‘working channel’. This allows the passage of instruments. For example, the doctor may take a small sample (biopsy) to send to the laboratory for processing.
The procedure usually takes around 15 minutes to complete. If you have an endoscopy procedure first, this will lengthen the entire duration to around 30 minutes. You should, however, allow 3 hours in hospital to include the admission process, the test and the recovery time afterwards. You will only be discharged when you are properly awake.
The doctor will send a report to the person who requested the test and may give you a copy to take with you. The doctor will also talk to you after the test but if you are slightly drowsy you may forget what is said. This is another good reason to have a friend or relative with you. If you ask the doctor, this person can be present during your conversations after the test.
Ultrasound is a high-frequency sound. It is a much higher frequency than you can hear but it can be created and detected by special machines.
Ultrasound travels freely through fluid and soft tissues. But it is reflected back as it hits denser, more solid surfaces. The pictures that the doctor sees on the screen is made up of the interaction between this high frequency sound and the different structures it comes into contact with. The more dense the structure, the more the sound is reflected and the stronger the image on the doctor’s screen. The resolution of EUS is approximately 1mm so very small abnormalities can be detected.
An EUS usually takes about 10-20 minutes. However, you should expect to spend around two to three hours in the hospital. This gives time to prepare, allow time for the sedative to work (if you have one), for the endoscopy itself, and to recover. An EUS does not hurt but it may be a little uncomfortable, particularly when you first swallow the endoscope.
The procedure is safe. Almost everyone gets a sore throat for two or three days after the procedure. Following sedation you may feel drowsy for a few hours so you should not drive or operate machinery until the next day.
Complications of endosopic ultrasound with aspiration of fluid into the lungs are very rare although recognised, particularly in people who have pre-exisiting lung conditions. Bleeding or infection may also occur rarely and, under certain circumstances, there is also a chance of making a hole (perforation) in the oesophageal wall. Again, the risk of this is very low.
If a patient has a growth and difficulty swallowing food, they may need treatment for this at the same time as the EUS is being done. The risks for each patient therefore depend on the exact procedure being done. The doctor will discuss your personal risks with you more fully before you consent to have the procedure.
As top private gastroenterologists, our endoscopic ultrasound specialists are all not only fee assured BUPA consultants but are also part of the BUPA Premier Consultant Partnership. This means that there are never any unexpected costs to BUPA insured patients.
We aim to ensure that patients insured with all the other major UK private healthcare insurance companies will also have their costs covered entirely by the insurance company. Patients should be aware that with the very wide variety of private insurance schemes on the market, they may have personal liabilities. This is particularly common with WPA patients who often agree to pay a proportion of all fees.
For patients who are uninsured, or who have insurance with non-UK based insurance companies, please request a formal quotation before having the procedure. The costs vary depending on the complexity of the case and whether other tests are being done at the same time.
Our helpful office staff will be pleased to assist you in organising your endoscopic ultrasound procedure at top London private hospitals. We offer this test at the London Clinic and Wellington Hospital endoscopy units.