Endoscopic Ultrasound Examination (EUS) Hepatobiliary Services Information for patients i
Introduction We hope that this booklet will help you to understand more about the procedure and the care that you will receive while you are in the Endoscopy Department. However, do not hesitate to ask your doctor, nurse specialist (key worker) or endoscopy staff if you have any further questions about the procedure. What is an Endoscopic Ultrasound (EUS)? This procedure involves using an endoscope (a long flexible tube) with a special probe that scans the surrounding structures. The probe uses high frequency sound waves to create pictures of nearby structures. As the probe can be placed very close to the organs, the images are very clear and even quite small abnormalities can be seen. This will allow us to assess your disease and, where necessary, take biopsies to confirm a diagnosis. These procedures are done to assess disease in relation to: the pancreas or the oesophagus or the lungs. Is there an alternative? The information obtained from this test is unique, and this procedure has fewer complications and risk than many other investigations. There are no real alternatives to this test. This procedure is generally performed under sedation. 2
What are the possible risks? You may have a sore throat for some hours after the procedure. There is a small risk of damage to crowned teeth or dental bridgework. Please tell a member of endoscopy staff before the procedure if you have any loose teeth, caps or crowns. Any dentures will need to be removed immediately before the procedure. Perforation (making a hole or tear) in the gullet, which may require urgent treatment or an operation. Bleeding, which may require you to be admitted to hospital and have a blood transfusion. Breathing difficulties as a result of the sedative you have been given. If biopsies are taken, there is a very slight risk of infection. If required, antibiotics may be given to help prevent infection. You will be closely monitored throughout the procedure. How do I prepare for the procedure? For the test to be carried out as safely as possible, it is vital that you do not have anything eat or drink for at least six hours before your appointment time. Please ensure that you have a responsible adult to drive you home and stay with you for 24 hours. This is essential as the sedation can remain in your body for up to 24 hours. If you require ambulance transport, please arrange this with your GP at least seven days before your appointment. If you are using hospital transport, you must have someone at home on your return to stay with you. 3
How do I prepare for the procedure? (continued) If you have no one available, then you will have to stay in hospital after the procedure. If there are no available hospital beds on the day of your procedure, then your appointment will have to be rebooked. Jewellery or metal objects should also be removed because they can interfere with the X-rays that may have to be used during the procedure. They will be kept safely until after the examination. Please leave all valuables at home. Please contact the Endoscopy Department for advice if you are currently taking warfarin or clopidogrel (Plavix ), or if you are diabetic. Please bring any current medications (including sprays and inhalers) with you to your appointment. What happens before the procedure? Your EUS will take place in the Endoscopy Department, at Leicester Royal Infirmary, Leicester General Hospital or Glenfield Hospital. Please check your appointment letter. 4 A doctor will explain the procedure to you in detail and will give you the opportunity to ask any questions you may have. You will then be asked to sign a consent form. This does not take away your right for the procedure to be stopped at any time you choose. An endoscopy nurse will stay with you throughout your test. You will be asked to remove your dentures and local anesthetic spray will be applied to the back of your throat to numb it. This has a bitter taste and you will notice a temporary loss of sensation in your throat and tongue. This will suppress your gag reflex.
What will happen during the procedure? You will then be made comfortable on a couch, where you will be asked to lie on your left hand side. Monitoring equipment will be attached to your right arm and one of your fingers. You will not need to remove your clothes, but you may be asked to loosen any clothing that fits tightly around your neck. A sedative will be given to you through a small plastic tube (cannula), which will be placed into a vein in your arm. This will be removed before you leave the Endoscopy Department to go home. To keep your mouth open, a small plastic mouth guard will be placed between your teeth and gums. You will be given oxygen through your nostril. The endoscope will be passed through your mouth, down your gullet and into your stomach. The test takes about 30 to 40 minutes, or more depending on the type of the procedure. During your test, photographs and ultrasound pictures may be taken and placed in your medical notes to allow other doctors involved in your care to see any abnormality. As we are a university teaching hospital for both doctors and nurses, students may be present on occasion as observers. If you would rather not have students observing, please let your nurse or doctor know before the procedure. 5
What happens when the procedure is over? You will be allowed to rest quietly in the recovery area where a qualified nurse will observe you until the main effects of the injection have worn off. You will be advised when you can eat and drink. After an EUS, patients are usually allowed home: please arrange for a relative or friend to collect you directly from the ward to take you home. Please ask the ward staff about what time to arrange your transport home. You will not be fit to go home by public transport. Once home you should rest quietly for the rest of the day. What should I avoid doing when I am discharged home? Remember that for the next 24 hours following your procedure, you must not: drink alcohol drive any vehicles (including motorcycles, bicycles, sit-on lawn mowers) take sleeping tablets operate any machinery or do anything requiring skill or judgment make important decisions or sign any legal or binding documents climb any ladders or chairs. 6
Things to report to your doctor Severe pain or vomiting Vomiting blood Temperature above 38 C Redness, tenderness or swelling at the site of the sedation injection that does not go away. For further information or advice please contact: The Endoscopy Department Your hospital consultant or GP Or call NHS 111 during out of hours. Your nurse specialist will be able to signpost you to sources of help and information about your disease. 7
If you would like this information in another language or format, please contact the service equality manager on 0116 250 2959 HPB Patient Information Group EUS Edition 3: January 2018 For review January 2021 CAN201-0118