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Endoscopic ultrasound examination of the bile ducts and pancreas


Medical editor Lars Aabakken MD
Gastroenterologist
Oslo University Hospital

General

In some cases, tumors in the bile ducts or pancreas are difficult to visualize by external ultrasound or CT/MRI. Endoscopic ultrasound-guided fine-needle aspiration (EUS) allows for ultrasound visualization of the area with high resolution and improved possibility for tissue sampling.    

Indications

  • Cancer in the liver/bile ducts
  • Cancer in the pancreas
  • Tissue sampling of small lesions which are not suitable for a percutaneous examination.

Goal

  • Diagnostics
  • Survey the relationship of the tumor to adjacent structures, for example blood vessels, focusing on operability.

Equipment

  • Ultrasound duodenoscope with accessories
  • Fine needle and equipment for preparing cytological specimens

Preparation

  • If the patient is treated with the anticoagulant warfarin, this must be discontinued 3 days before the examination when tissue sampling is an option.
  • The patient must be fasting for 6 hours before the examination.
  • The examination is normally performed under light sedation or local anesthesia sprayed in the throat.
  • The patient lies on their left side on the examination table.
  • A hollow mouth piece is put between the teeth for insertion of the scope.

Implementation

  • The scope is carefully inserted through the mouth down to the stomach and the duodenum.
  • The ultrasound probe on the end of the endoscope is placed toward the stomach/intestinal wall. The rest of the examination focuses on the ultrasound images.
  • If necessary, a needle can be inserted through the endoscope for aspiration of test material. The specimen is prepared and assessed by a cytologist. 

Follow-up care

  • The patient may eat/drink at the earliest 1 hour after the procedure due to the local anesthesia of the throat.
  • The examination is performed on an outpatient basis and the patient may return home after 1–2 hours.
  • The result is usually available within a week.

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