EUS helps your doctor determine the extent of spread of certain cancers of the digestive and respiratory systems. EUS allows your doctor to accurately assess the cancer’s depth and whether it has spread to adjacent lymph glands or nearby vital structures, such as major blood vessels. In some patients, EUS can be used to obtain a needle biopsy of a lump or lesion to help your doctor determine the proper treatment.

For EUS of the upper gastrointestinal tract, you should have nothing to eat or drink, usually for six hours before the examination. Your doctor will tell you when to start this fasting and whether it is advisable to take your regular prescription medications.
For EUS of the rectum or colon, your doctor will instruct you to either consume a colonic cleansing solution or to follow a clear liquid diet combined with laxatives or enemas prior to the examination. The procedure might have to be rescheduled if you don’t follow your doctor’s instructions carefully.

You can take most medications as usual until the day of the EUS examination. Tell your doctor about all medications that you’re taking and about any allergies you have. Anticoagulant medications (blood thinners such as warfarin or heparin) and clopidogrel may need to be adjusted before the procedure. Insulin also needs to be adjusted on the day of EUS. In general, you can safely take aspirin and non-steroidal anti-inflammatory medications (ibuprofen, naproxen, etc.) before an EUS examination. Check with your doctor in advance regarding these recommendations. Check with your doctor about which medications you should take the morning of the EUS examination, and take only essential medications with a small sip of water. If you have an allergy to latex, you should inform your doctor prior to your test. Patients with latex allergies often require special equipment and may not be able to have a complete EUS examination.

Antibiotics are not generally required before or after EUS examinations. However, your doctor might prescribe antibiotics if you are having specialized EUS procedures, such as to drain a fluid collection or a cyst using EUS guidance.
Practices vary among doctors, but for an EUS examination of the upper gastrointestinal tract, some endoscopists spray your throat with a local anesthetic before the test begins. Most often you will receive sedatives intravenously to help you relax. You will most likely begin by lying on your left side. After you receive sedatives, your endoscopist will pass the ultrasound endoscope through your mouth, esophagus and stomach into the duodenum. The instrument does not interfere with your ability to breathe. The actual examination generally takes less than 60 minutes. Many do not recall the procedure. Most patients consider it only slightly uncomfortable, and many fall asleep during it. An EUS examination of the lower gastrointestinal tract can often be performed safely and comfortably without medications, but you’ll receive a sedative if the examination will be prolonged or if the doctor will examine a significant distance into the colon. You will start by lying on your left side with your back toward the doctor. Most EUS examinations of the rectum generally take less than 45 minutes. You should know that if a needle biopsy of a lesion or drainage of a cyst is performed during the EUS, then the procedure will be longer and may take up to two hours.

If you received sedatives, you will be monitored in the recovery area until most of the sedative medication’s effects have worn off. If you had an upper EUS, your throat might be a little sore. You might feel bloated because of the air and water that were introduced during the examination. You’ll be able to eat after you leave the procedure area, unless you’re instructed otherwise. Your doctor generally can inform you of the preliminary results of the procedure that day, but the results of some tests, including biopsies, may take several days.

Although complications can occur, they are rare when doctors with specialized training and experience perform the EUS examination. Bleeding might occur at a biopsy site, but it’s usually minimal and rarely requires follow-up. You might have a slight sore throat for a day or so. Nonprescription anesthetic-type throat lozenges help soothe a sore throat.
Other potential but uncommon risks of EUS include a reaction to the sedatives used, aspiration of stomach contents into your lungs, infection, and complications from heart or lung diseases. One major but very uncommon complication of EUS is perforation. This is a tear through the esophagus, stomach or lining of the intestine that might require surgery to repair. The possibility of complications increases slightly if a needle biopsy is performed during the EUS examination, including an increased risk of pancreatitis or infection. These risks must be balanced against the potential benefits of the procedure and the risks of alternative approaches to the condition.

Make the best choice. If you need an endoscopic procedure, ask your primary care doctor to recommend a specialist in gastrointestinal endoscopy who is also an ASGE member. ASGE members are distinctively qualified to perform the gastrointestinal endoscopic procedures that your primary care physician or other healthcare provider recommends and to work with you and your primary care provider on issues of digestive health.

ASGE can help you find a GI endoscopist in your area. It’s easy. Visit the ASGE Web site at www.asge.org and click on the Find a Doctor. By typing in your zip code, the Find a Doctor program will give you a list of the ASGE members in your area. Remember, you can always ask if your physician is an ASGE member.

ASGE offers additional materials on GI endoscopy and endoscopic procedures, including brochures on Upper GI Endoscopy, Endoscopic Ultrasound, ERCP, Flexible Sigmoidoscopy, and Colonoscopy on the ASGE Web site at www.asge.org as well as other useful information on digestive health and gastrointestinal problems.

ASGE Active Physician Members have met the following rigorous requirements:
Unlimited medical license.Graduation from an accredited medical school and completion of a residency program.Documented evidence of formal training in gastrointestinal endoscopy under the supervision of certified gastroenterologists or gastrointestinal surgeons – ASGE is the only society that requires evidence of such training.Finally, ASGE Active Members must provide evidence of professional competence through sponsorship by at least one member who has personal knowledge of the applicant’s endoscopic training and skills.Be certain your physician meets the high standards of ASGE membership.

The dissemination and implementation of the guidelines for endoscope reprocessing (cleaning and disinfecting) outlined here have resulted in a remarkable safety record for endoscopy. Based on medical literature, the Technology Committee of the ASGE estimates that the chance that a serious infection could be transmitted by endoscopy is only about 1 in 1.8 million. Given the multiple benefits of endoscopy, it is no wonder that the number of procedures performed grows each year and that endoscopy is a mainstay of digestive disease treatment plans and health maintenance strategies. Endoscope manufacturers are continually improving the design of endoscopes to ensure patient safety.

Any facility in which gastrointestinal endoscopy is performed must have an effective quality assurance program in place to ensure that endoscopes are reprocessed properly. Quality assurance programs for endoscopy must include the supervision, training, and annual competency review of all staff involved in the process, systems that assure availability of appropriate equipment and supplies at all times, and strict procedures for reporting possible problems.

The ASGE guidelines for infection control during gastrointestinal endoscopy provide the latest techniques and step-by-step directions on the proper procedure for cleaning and disinfecting endoscopes. These are distributed to all members of ASGE and are regularly reviewed and updated. They are also easily accessed on the ASGE Web site (www.asge.org) or by calling or writing ASGE.

Prior to the performance of a procedure, an endoscope must be carefully cleaned and disinfected according to guidelines published by the American Society for Gastrointestinal Endoscopy, which have been endorsed by every major medical association dealing with endoscopy and infection control. The steps involved in cleaning and disinfecting an endoscope are as follows:
Mechanical cleaning. The operating channels and external portions of the endoscope are washed thoroughly, wiped with special liquids that contain enzymes, and brushed with special cleaning instruments. Studies have shown that these steps alone can eliminate potentially harmful viruses and other microbes from an endoscope. However, much more is done before the endoscope is considered ready for use.
Leakage testing. The endoscope is tested to be sure that there are no leaks in its internal operating channels. This not only ensures peak performance of the endoscope, but also allows immediate detection of internal defects that could be a potential focus of infection within the device. Despite its complex electronics, an entire endoscope can be submersed completely in liquid so that leakage testing can be carried out.
Use of chemical disinfectants. Next, the endoscope is soaked continuously for an appropriate time period with one of several approved liquid chemicals that destroy microorganisms that can cause infections in humans, including the AIDS virus, hepatitis viruses, and potentially harmful bacteria. There are a variety of chemical disinfectants used to achieve high-level disinfection. This process eliminates virtually all microbial life except for some inactivated dormant organisms known as spores. However, spores are uncommonly found in endoscopes and, even if present, are not harmful to humans. Although most high-level disinfectants are also sterilants (which kills all spores), this requires a much longer exposure time, and has not been shown to be necessary. The human mouth, small intestine, colon and rectum contain millions of non-harmful bacteria. Therefore, as soon as the endoscope touches the internal surface of a patient, it is not sterile. The goal of a “sterile” endoscope from the beginning to the end of a procedure is not achievable. Therefore, the goal of reprocessing is to eliminate from the endoscope any potentially harmful microbes. This goal can be achieved with high-level disinfectant chemicals and by following standard reprocessing guidelines.
Rinsing and drying. After exposure to the chemical disinfectant, the endoscope channels are flushed with sterile water followed by alcohol and then air dried to eliminate any moisture that could be a site of bacterial growth from the environment. The endoscope is then stored on a specialized hanger to keep it dry and free of contamination.