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Endoscopic Ultrasound benefits and risks

Endoscopic Ultrasound benefits and risks

Endoscopic Ultrasound

Information for patients

An endoscopic ultrasound is used to diagnose problems in your upper gastrointestinal tract. These problems may be associated with growths or obstructions in the ducts including the oesophagus, stomach, duodenum and adjacent organs (such as the pancreas).

It involves passing a small tube (scope) over your tongue, down your gullet, into your stomach and duodenum. This is a flexible tube with a light, a small ultrasonic device and a camera in its tip. Air is then put into your stomach allowing the endoscopist to carry out the examination.

This procedure can help us to:

  • identify very small growths (less than 1cm)
  • identify gallstones
  • examine glands
  • obtain biopsy (tissue sample)
  • establish whether you need surgery and best method for you

Although complications are rare you should be aware of the following:

  1. Loose teeth, crowns and bridgework can be dislodged.
  2. A small hole, called a perforation, can be made during the procedure (the risk is approximately one in 1000). This risk will be slightly raised if abnormality such as a narrowing or growth is encountered (one in 500). If therapeutic intervention (treatment) is performed such as stretching the narrowing, the possibility can be up to one in 10 procedures. You may need to stay in hospital if it happens.
  3. Very frail and/or elderly patients can get pneumonia from stomach juices getting into the lung.
  4. The sedation (if given) can cause agitation, difficulty breathing (which can increase the risk of pneumonia) or respiratory arrest (though this is very rare).
  • A CT scan can be performed, but the investigation is less sensitive, and small lesions (less than 1cm) can be missed.
  • A barium meal can provide x-ray images of the gastro-intestinal tract, but a biopsy cannot be obtained.

Please tell us if you have any allergies

Consent: We must by law obtain your written consent to any operation and some other procedures beforehand. Staff will explain all the risks, benefits and alternatives before they ask you to sign a consent form. If you are unsure about any aspect of the treatment proposed, please do not hesitate to speak with a member of the nursing or medical staff.

The nurse will give you a consent form when you arrive. Please read it carefully while you are waiting. In the procedure room, the endoscopist will explain the procedure to you in detail and ask you to sign the form. If you have any questions, please feel free to ask.

Before the procedure takes place, a nurse will show you to your cubicle and ask you to put on a hospital gown. After you have changed, you can then relax on your trolley until it is your turn to be examined.

Please tell a member of staff if you have any mobility problems as you may be required to roll from side to side on the trolley during the procedure.

Before the procedure you must remove the following as they can cause discomfort and will interfere with the instruments used:

  • Contact lens
  • Jewellery (including body piercing)
  • False teeth (you can keep these in until immediately before the procedure)

Hearing aids can be left in-situ throughout the procedure.

You will be attached to a monitor and given oxygen. You will then be asked to lie on your left side and a mouth guard will be placed in your mouth. This enables the scope to pass through. When the ultrasound scope is inserted in the appropriate position, ultrasound images will be generated. No radiation is involved. A nurse will remain with you to reassure you and to clear away any saliva from your mouth. During the examination, the endoscopist may take some biopsies (tissue samples). This is painless.

Sedation

To put you at ease you will be given intravenous analgesic (painkillers) and sedatives. The medicine will be given via a cannula (small tube) in your hand or arm. It will relax you and may make you drowsy but will not put you to sleep. You will be able to hear and respond to any instructions given to you.

You may want to bring something to read – don’t forget your reading glasses, as you will need to sign your consent form.

We will give you a hospital gown to protect your own clothing so you do not need to bring anything to change into.

Valuables

Please do not bring in valuables, jewellery or large sums of money. If this is unavoidable, please ask a relative to take them home for you. If this is not possible, hand in any valuables to the nurse in charge of endoscopy unit (or the ward sister if you are inpatient) on your arrival. They will be listed and locked in a safe and you will be given a receipt. The hospital cannot accept liability for the loss of items that are not handed in for safekeeping.

Your details will be taken and checked by our receptionist. A nurse will take your blood pressure and ask you some questions related to your health. You will have already been given a health questionnaire, which we recommend you complete at home in peace, so that you will not forget some valuable information.

The actual procedure takes about 30-45 minutes, but please be prepared to remain with us all morning or afternoon, depending on your appointment time.

If someone accompanied you they are welcome to stay or we can contact them later when you are ready to go home.

You must not eat anything or drink any milk for six hours before your examination. However, you may continue to drink clear liquids such as black tea or coffee, sugary drinks and clear soup for up to two hours before your appointment time.

If you are diabetic and taking medication (either tablets or insulin), you should test your blood or urine for glucose before you start your preparation, and then at least every four hours until you leave home for your appointment.

  • If the result is higher than 10mmol/L, continue with your medication. You may drink sugary drinks to maintain you blood sugar level up to two hours before your appointment time.
  • If it is lower than 10mmol/L, delay your medication until you start eating again.
  • You may need to readjust your normal dosage according to the blood sugar level.

If you are taking warfarin or heparin, please contact the Endoscopy. This is because your blood clotting time will need to be checked before the procedure. It may be necessary to suspend your medication until after your examination.

Do not take aspirin on the day of your procedure.

Take all other medication as prescribed.

Please remember the following points

  1. You will have to stay with us for one or two hours as the sedation will make you a little sleepy.
  2. You must be accompanied home by a responsible adult and have someone with you overnight.
  3. The effect of the sedative can last up to 36 hours so you must not drive, operate machinery or drink alcohol during that time.
  4. If any polyps are removed or any biopsies taken, you may notice a small amount of blood next time your bowels open. You may wish to limit your general activity for a day or two.
  5. As soon as you are ready you will be offered tea or coffee.
  6. You may experience mild stomach cramps from the air that was introduced into your stomach during the procedure. This will soon disappear.
  7. A report will be sent to your referring doctor.
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