Having an Endoscopic Ultrasound and Fine Needle Aspiration / Biopsy
Your doctor has recommended that you have an Endoscopic Ultrasound (EUS) with possible Fine Needle Aspiration / Biospy (FNAB). This leaflet will explain the procedure and what to expect on the day of your test. If you have further questions, please telephone the department or discuss them with a member of staff on the day of your procedure.
What is an Endoscopic Ultrasound
An Endoscopic Ultrasound (EUS) is a test similar to a gastroscopy, which you may have already had. During the test, a tube similar to the camera passed during a gastroscopy is passed into your oesophagus (gullet) and stomach. The tube has a small ultrasound scanner and balloon at the tip which allows us to get a detailed scan of different areas. The test takes 30 minutes but may be longer if biopsies (small tissue / fluid samples) are taken.
You can expect to be in the endoscopy unit for about 2-4 hours.
What is a Fine Needle Aspiration / Biopsy (FNAB)
Sometimes, during the procedure, the doctor will want to obtain more tissue (biopsy) or fluid samples (aspiration) to help with your diagnosis and / or treatment. This involves passing a very narrow needle through the endoscope to obtain samples from hard-to-reach areas such as your pancreas. A fine needle aspiration / biopsy (FNAB) takes longer than a standard EUS, sometimes up to 1 hour. You will need to remain in the recovery room for 2 hours after your procedure for observation.
Why am I having an Endoscopic Ultrasound?
An Endoscopic Ultrasound allows us to obtain images and information about your digestive tract (gullet, stomach, and duodenum) and the surrounding tissues and organs, for example, your bile duct or pancreas.
What are the benefits of having an Endoscopic Ultrasound?
Endoscopic Ultrasound is the most accurate way of diagnosing and assessing certain conditions relating to the oesophagus, stomach and pancreas. The information gained during your test will assist your doctor in deciding the best treatment for you. If you prefer not to have this investigation, we advise you to discuss the implications with your doctor.
What are the alternatives to having an Endoscopic Ultrasound?
The alternatives depend on the reason for performing the test but usually, endoscopic ultrasound is complimentary to other tests that you may have already had such as a CT scan.
What are the risks of having an Endoscopic Ultrasound?
Endoscopic Ultrasound is generally a safe procedure; complications are rare but can occur. The risks associated with your test are detailed on your consent form and below. Please read this. You should be aware of the risks before you sign the consent form. If you have any questions, speak to the nurse or endoscopist on the day of your test, or alternatively, ring the Endoscopy Unit. As with any medical procedure, the risk must be compared to the benefit of having the procedure carried out.
Side-effects
Common side effects are:
- A sore throat after the examination is common and should resolve after 24 hours.
- Abdominal discomfort or bloating during the procedure.
- Minor bleeding.
More serious, but rare complications are:
- Making a hole in the digestive system (perforation). If this did happen, you may require an operation.
- Causing an infection or pancreatitis (if FNA biopsy of the pancreas is performed), sometimes, antibiotics are given during the procedure for this.
- Using sedation can affect your breathing. To reduce this risk, we monitor your pulse and oxygen level.
- Damage to loose teeth, crowns or to dental bridgework.
How do I need to prepare for the procedure?
Endoscopic Ultrasound must be performed on an empty stomach.
If your appointment’s in the morning:
- do not have anything to eat or drink from midnight of the night before the examination. Food or liquids will obscure the view of the endoscope and the examination will not be possible.
- you can have a small glass of water no later than 2 hours before your appointment time
- bring your regular medication with you and you can take it after your procedure.
If your appointment’s in the afternoon:
- have a light breakfast before 8am. We recommend toast and tea. Do not eat porridge or eggs.
- have your last drink at least 4 hours before your appointment. Avoid milky drinks.
- have a small glass of water no later than 2 hours before your appointment time.
- if you take regular medication in the morning, take it as usual.
If you are unable to attend your appointment, please phone the Endoscopy department at the earliest opportunity on 01296 315175 so that we can reschedule your appointment.
Should I keep taking my tablets?
You must keep taking any essential tablets unless your doctor tells you specifically not to. Please take your tablets early morning with a sip of water.
If you have any questions about your medication or if you are diabetic, have sleep apnoea or are taking tablets that prevent blood clots, please contact the endoscopy booking clerk or nursing team when making your appointment.
Examples of blood thinning tablets include:
- Warfarin
- Dabigatran
- Apixaban
- Edoxaban
- Rivaroxaban
- Aspirin
- Clopidogrel (Plavix)
- Dipyridamole (Persantin)
- Prasugrel (Efient)
- Ticagrelor (Brilligue)
- Acenocoumarol (Sinthrome).
What should I bring on the day?
Please bring a list of medication that you take and any medication that you may require whilst in the department such as GTN spray, inhalers and insulin.
Please do not bring valuables to the department or wear lots of jewellery.
Please can you also ensure that you remove nail varnish as this interferes with the signal we receive from our monitors about your oxygen levels.
Will I be asleep for my Endoscopic Ultrasound?
Endoscopic Ultrasound is normally carried out under sedation. Sedation is not a general anaesthetic and will not put you to sleep; however, it may make you feel relaxed and possibly, a little drowsy.
After the test, you will have to rest in the recovery area so we can monitor your recovery from the sedative, this can take 1 to 3 hours. You MUST bring someone with you and go home in a car / taxi, not on public transport, as you may be unsteady on your feet due to the sedation. You must also have someone at home to care for you for 24 hours after the procedure and must rest indoors. This means no work, no driving, no alcohol and you shouldn’t operate machinery.
Sedation will not be given if the above are not arranged before the test. If you are unable to organise this, please contact the Endoscopy Unit for advice.
Risks from drugs administered
There are known adverse effects from the intravenous drugs administered during the procedure. Mild conditions such as headaches and nausea and fainting are relatively common. More serious side effects, such as depression of respiratory and nervous systems (which may result in aspiration pneumonia, anaphylaxis and coma) are rare. However, they are less rare in patients with deeper sedation and / or general anaesthesia.
What will happen on the day of the test?
When you arrive at reception in the Endoscopy Unit, your personal details will be checked. The assessment nurse will collect you and take your medical history, discuss and explain the test, and take your blood pressure and pulse. You will be able to ask any questions and discuss any worries that you have about the test. The endoscopist will discuss the consent form with you before your test. Remember, you can change your mind about having this procedure at any time.
Please note: every effort will be made to see you at your appointment time; however, due to hospital inpatient emergencies delays may occur. The endoscopy staff will keep you informed of any delays
What happens in the procedure room?
You will be greeted by two nurses who will remain with you during the test. The nurses and the endoscopist will complete a checklist to ensure all your information is correct. A cannula will be placed in your vein so that sedation can be administered, and you will be given oxygen through a small plastic tube in your nose. If you are having throat spray, your throat will be numbed.
You will then be asked to remove any dentures or glasses and lay on a trolley on your left-hand side. Your pulse and oxygen levels are monitored by a probe placed on your finger during the test.
Before the test starts, a plastic mouthpiece is placed between your teeth to keep your mouth slightly open. When the endoscopist gently passes the endoscope through your mouth, you may gag slightly – this is quite normal and will not interfere with your breathing. Any saliva or other secretions produced during the procedure will be removed using a small suction tube, like the one used at the dentist.
When the procedure is finished, the endoscope is removed quickly and easily. If you become very uncomfortable or withdraw consent, the procedure will be stopped.
Please note: It may be that a doctor training to do endoscopic ultrasound performs your procedure under the direct supervision of a consultant. If you do not wish students to be present, please inform the endoscopist.
What happens after the test?
You will be transferred to the recovery room after the test. The recovery nurse will monitor you during your recovery, prepare you for discharge and give you aftercare instructions. this can take 1 to 2 hours.
Remember: if you have sedation, you will need an escort with you, transport home and someone to look after you for 24 hours after the test. You must not:
- Drive a vehicle.
- Drink alcohol.
- Operate machinery.
- Go to work
- Sign legal documents.
When will I get my results?
A full report will be sent to your referring doctor. The results of this test need to be combined with the results of other tests you may have had and therefore, the report will be sent to your consultant who will be fully aware of all your other examinations. This leaflet has been designed as a general guide to your test. If after reading this, you have any questions that you feel have not been answered, please contact the Endoscopy department.
How to seek help after the test
If you experience any severe chest or abdominal pain, particularly on swallowing, or if you vomit blood, please seek help immediately.
During normal office hours ring the relevant Endoscopy Unit:
- Stoke Mandeville Hospital – 01296 315220
- Wycombe Hospital – 01494 425073
Outside office hours, patients who have had their procedure in Wycombe or Stoke Mandeville hospitals should call Ward 17 at Stoke Mandeville Hospital on 01296 418201.
In an emergency you can come directly to Stoke Mandeville Hospital Emergency Department
Useful Links:
Buckinghamshire Healthcare NHS Trust Website www.buckshealthcare.nhs.uk/gastro
British Society of Gastroenterology Website http://www.bsg.org.uk/
Guts UK Digestive Disorders Information Website gutscharity.org.uk