What should be known prior to performing EUS?

Abstract

Direct referral of patients for EUS – instead of preprocedural consultation with the endosonographer – has become standard practice (like for other endoscopic procedures) as it is time- and cost-effective. To ensure appropriate indications and safe examinations, the endosonographer should carefully consider what information is needed before accepting the referral. This includes important clinical data regarding relevant comorbidities, the fitness of the patient to consent and undergo the procedure, and the anticoagulation status. In addition, relevant findings from other imaging methods to clarify the clinical question may be necessary. Appropriate knowledge and management of the patients’ anticoagulation and antiplatelet therapy, antibiotic prophylaxis, and sedation issues can avoid unnecessary delays and unsafe procedures. Insisting on optimal preparation, appropriate indications, and clear clinical referral questions will increase the quality of the outcomes of EUS. In this paper, important practical issues regarding EUS preparations are raised and discussed from different points of view.

Do we need elastography for EUS?

“…[ 15 ] Moreover, this may be particularly helpful if the region is not easily accessible by EUS needles, in patients with contraindications against fine-needle puncture and if multiple suspicious areas are present. [ 21 54 55 58 59 ] The use of elastography in pancreatic diseases and for characterization of LNs is recommended by the EFSUMB guidelines. [ 15 60 ] In 2015, clinical practice guidelines for elastography specific to the pancreas were published by the Japanese Society of Medical Ultrasonics.…”

Do we need contrast agents for EUS?

“…Routine use of CE-EUS should be encouraged as it offers complementary information over grayscale and elastographic imaging results. [ 81 82 ] The procedure is safe and carries a negligible risk of adverse events to patients. As UCAs are not excreted through the kidneys, they can be safely administered to patients with renal insufficiency.…”

What should be known prior to performing EUS exams? (Part II)

“…Knowledge of a patient's diagnosis prior to EUS examination may influence the scheduling and conduct of the procedure. [6] Unexpected findings during such examinations may provide new perspectives to a known disease, such as previously undetected liver metastasis in a patient with pancreatic adenocarcinoma. EUS may also reveal previously undetected metastasis in unexpected locations, for instance, a patient with proximal squamous cell carcinoma of the esophagus could be found to have suspicious retroperitoneal lymph nodes at EUS staging, with subsequent EUS-FNA providing proof of abdominal metastasis and systemic disease.…”