Endoscopic Ultrasound (cont.)

When is EUS useful?

Being a relatively new diagnostic tool the uses for EUS are still being developed and, presently, it is being utilized in some of the following situations:

• Staging of cancers of the esophagus, stomach, pancreas and rectum.
• Staging of lung cancer.
• Evaluating chronic pancreatitis and other masses or cysts of the pancreas.
• Studying bile duct abnormalities including stones in the bile duct or gallbladder, or bile duct, gallbladder, or liver tumors.
• Studying the muscles of the lower rectum and anal canal in evaluating reasons for fecal incontinence.
• Studying 'submucosal lesions' such as nodules or 'bumps' that may be hiding in the intestinal wall covered by normal appearing lining of the intestinal tract.

Staging of cancer is becoming an important use of EUS. The prognosis of a cancer victim is related to the stage of the cancer at the time of cancer detection. For example, early stage colon cancer refers to cancer confined to the inner surface of the colon before it is spread to adjacent tissues or distant organs. Therefore early stage colon cancer can be completely resected with good chances for cure. However, if cancer is detected at later stages, the cancer tissues have already penetrated the colon wall and invaded neighboring organs and lymph nodes, or have spread to distant organs such as liver and lungs. Complete surgical excision becomes highly unlikely. EUS can provide information regarding the depth of penetration of the cancer and spread of cancer to adjacent tissues and lymph nodes, information useful for staging.

What is the preparation for EUS?

Your doctor will want to know about your health status especially if you have any allergies, other significant health problems such as heart disease, lung disease, diabetes mellitus, etc.You will also be inquired about allergies to iodine or shellfish as, under certain circumstances, iodine containing contrast material may be used. If there is a possibility of fine needle aspiration (FNA), the doctor will want to check your blood for proper clotting. It is important to inform your doctor of any family history of bleeding problems or if you are taking medications that interfere with blood clotting (such as Coumadin) or platelet function (such as aspirin, Motrin, ibuprofen, Aleve, and other NSAIDs). The wisest is to inform you doctor of any prescription or non-prescription medication you might be taking. Antibiotics are usually not required except in patients with certain heart valve problems.

EUS is performed with sedation so you will not be able to return to work or to drive for 24 hours. It also means that you will need someone to take you home as this is usually an out-patient procedure.

You will need to have an empty stomach that means no oral intake for 6 or more hours. In case of a rectal EUS you will probably need to take some enemas or laxatives. In either case, full instructions will be given to you.