Endoscopic Ultrasound (EUS)

Examination combining endoscopy and ultrasound to obtain precise images of the digestive walls and adjacent organs, essential for the assessment of certain digestive and pancreatic conditions.

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What is it?

Endoscopic ultrasound (EUS) is a high-precision examination that combines digestive endoscopy and ultrasound imaging. An endoscope fitted with a miniaturized ultrasound probe at its tip is introduced into the digestive tract, making it possible to perform an ultrasound scan from inside the body itself. This technique provides images with a higher resolution than those obtained by transcutaneous ultrasound or CT scan. This examination is particularly effective for exploring the pancreas, the bile ducts, the wall of the esophagus, stomach and rectum, as well as the mediastinal and abdominal lymph nodes. EUS makes it possible to precisely assess the depth of invasion of digestive tumors (staging), to characterize submucosal lesions and to detect small pancreatic or biliary lesions not visible on other imaging examinations. Endoscopic ultrasound can also be interventional: it allows fine-needle aspiration of suspicious lesions or lymph nodes to obtain a precise cytological or histological diagnosis. This minimally invasive technique often avoids the need for diagnostic surgical procedures. At Clinique Pasteur in Tunis, endoscopic ultrasound is performed by specialized gastroenterologists with state-of-the-art equipment. The examination is carried out under deep sedation for the patient's comfort, under optimal safety conditions.

When is it indicated?

Staging of cancers of the esophagus, stomach, rectum and pancreas

By placing the ultrasound probe in direct contact with the lesion, this examination precisely measures the depth of a tumor within the digestive wall, essential information for choosing the best treatment.

Exploration of pancreatic tumors or masses

The pancreas is a deep organ that is difficult to examine from the outside. EUS gets as close to it as possible and can detect very small lesions invisible on other examinations.

Exploration of the bile ducts (stones, tumors)

When a stone or an obstruction is suspected in the ducts that carry bile, this highly sensitive examination can confirm or rule it out before considering a therapeutic procedure.

Characterization of submucosal lesions of the digestive tract

Some bumps seen during a standard endoscopy develop beneath the surface of the wall. Internal ultrasound shows which layer they arise from and helps clarify their nature.

Needle aspiration of suspicious masses or lymph nodes

Under ultrasound guidance, a very fine needle can sample a few cells from a suspicious lesion or lymph node. This sampling provides a precise diagnosis while avoiding surgery.

Exploration of pancreatic cysts or pseudocysts

When facing a fluid-filled pocket in the pancreas, the examination studies its contents and walls to distinguish harmless cysts from those requiring surveillance or treatment.

Assessment of chronic pancreatitis

In case of prolonged inflammation of the pancreas, EUS finely assesses the condition of the gland and its ducts, which helps monitor the disease and adjust its management.

Drainage of fluid collections

Some pockets of fluid that form around the pancreas can be drained directly through the stomach wall, under ultrasound guidance, thereby avoiding more invasive surgery.

Preparation

1Fast strictly for at least 6 hours before the examination

2Report any anticoagulant or antiplatelet treatment (may need to be stopped before a needle aspiration)

3Bring a recent coagulation panel if a needle aspiration is planned

4Mandatory pre-anesthesia consultation

5Bring the results of previous imaging (CT scan, MRI, ultrasound)

6A companion is mandatory for the trip home

Procedure

Deep sedation is administered by the anesthesiologist

The echoendoscope is introduced through the mouth (upper route) or through the anus (lower route, depending on the indication)

The endoscope is positioned facing the area to be explored

The ultrasound probe produces real-time images of the digestive wall and adjacent organs

The physician analyzes the size, structure and extension of the lesions

If indicated, a fine-needle aspiration is performed under ultrasound guidance

The samples are sent to the laboratory for analysis

The patient is monitored in the recovery room for 1 to 2 hours

Duration

30 to 60 minutes for the examination, 2 to 3 hours in total

Results

The imaging findings are communicated by the gastroenterologist in the days following the examination. The results of needle aspirations are available within 7 to 14 days.

Risks and side effects

Mild sore throat or abdominal discomfort (common and transient)

Bleeding at the puncture site (rare)

Acute pancreatitis after pancreatic puncture (rare, about 1 to 2 %)

Digestive perforation (exceptional)

Infection (very rare)

Anesthesia-related complications (rare)

These risks remain rare. Your physician will inform you in detail before the examination.

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At a glance

Duration: 30 to 60 minutes for the examination, 2 to 3 hours in total

Preparation: Required

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