An endoscopic ultrasound helps to find the cause of your symptoms.
The upper gut consists of the oesophagus (gullet), stomach and duodenum (part of the small intestine joining the stomach). Endoscopic ultrasound is a procedure that combines the ability to look directly at the lining of the upper gut with a video camera, whilst also showing the structures that lie outside the gut (such as the pancreas) using ultrasound.
This is done using an ultrasound scope, which is a long thin flexible tube with a light and an ultrasound probe at the end of it. It is passed into the mouth and on to the gullet (oesophagus), stomach and sometimes the duodenum. This is not a painful procedure and takes between 10 -20 minutes, if it takes longer, you should not worry. During the procedure the doctor may wish to take tissue samples. This is called Fine Needle Aspiration (FNA). You should not feel them being taken.
You have the choice of sedation or local anaesthetic throat spray. It is recommended that you have sedation for this procedure.
Although the procedure does not take long, you may be in hospital for 3-4 hours depending on whether you have had a FNA done. If you have had sedation you will need time to recover.
It is important that a friend or relative accompany you home and stay with you overnight.
If you had local anaesthetic spray you can go home alone and may be able to drive.
What are the risks associated with this procedure?
- Bloating and abdominal discomfort is not unusual for a few hours
- You may have a sore throat for 24 hours
- There may be a slight risk to teeth, crown or, dental bridge work, you should tell the nurses if you have either of these.
- Using sedation can cause breathing complications in up to 1 in 200 procedures, which are not serious.
- Diagnostic endoscopic ultrasound procedure carries a very small risk (1 in 10,000 cases) of haemorrhage (bleeding) or perforation (tear) of the gut following the procedure. If samples are taken, these risks are increased. Should such complications occur you may require surgery to repair it.
- For patients having a sample (FNA) of their pancreas, there is an increased risk of developing pancreatitis (inflammation in the pancreas gland). Mild pancreatitis develops in up to 7 out of 100 patients who have sampling of the pancreas and is usually mild and goes away within a few days. Occasionally, very rarely, the pancreatitis can be very severe and life threatening; this happens in only a very small minority of patients (about 5% of all patients who develop pancreatitis after FNA).
- Other very rare complications include aspiration pneumonia (inflammation of the lungs caused by inhaling secretions from the mouth) or adverse reactions to intravenous sedative drugs.
- No test is 100% accurate and abnormalities may be missed, including cancers.
The person doing the test will discuss any worries you have about the risks associated with this procedure
What are the benefits of this procedure?
The procedure is to help diagnose your problem. Like all tests, this is not guaranteed to demonstrate all abnormalities and on rare occasions conditions are not identified.
What are the alternatives?
This is the most accurate way to investigate and diagnose certain problems in the upper abdomen. Alternatives are other scans, such as CT or MRI scanning.
Preparing for Endoscopic Ultrasound
Please read the information enclosed carefully. If you have any queries, contact the unit where you will be having your procedure.
If you are diabetic, on warfarin, clopidogrel, rivaroxaban, apixaban, or dabigatran please contact the unit for further information. Please bring any medication you are currently taking (including sprays and inhalers) with you to your appointment. If you are taking a number of tablets please bring in your repeat prescription sheet.
If you take medication for your blood pressure, please make sure you take this as usual prior to your procedure with small sips of water (at least two hours before)
To allow a clear view the stomach must be empty, so please follow these instructions:
- do not have anything to eat for at least six hours before the test
- do not drink milk for four hours before your test. Milk will line the stomach and not allow a clear view of the lining
- you may drink clear fluids (water, black tea or black coffee) up to two hours before the time of the appointment
When you arrive at the hospital
Please report to the reception desk where a receptionist will check your details and direct you to the waiting area. Please be aware the appointment time you have been given, will be your admission time. Your procedure will be carried out as near to this time as possible however on occasions due to emergency patients being seen, this may be delayed.
- Please do not bring any valuables to the hospital with you
- Please do not wear any nail varnish, lipstick or jewellery (tongue studs must be removed
- Please bring a contact number of a relative or friend with you
A nurse will then explain the procedure to you, to make sure you understand the benefits, and possible risks as detailed in this leaflet. The staff will want you to be as relaxed as possible and will not mind answering your questions.
Provided you are happy for the procedure to be performed, you will be asked to sign the consent form to confirm your understanding of the procedure. You will be offered a copy of this.
Your consent to further procedures may be necessary, including taking tissue samples (biopsies) that may be helpful in diagnosing your problem. Tissue may be used for research but you can request that no removed samples be used for this purpose on your consent form.
Just before the procedure you will also see the person who will be performing the test and provided you are happy for the procedure to be performed, they will ask you to confirm your agreement and they will also sign your consent form.
If you need the help of an interpreter to understand any of this information, or on the day of the procedure, please contact the unit where you will be having the test, as soon as possible.
Please note relatives/friends or children should not be used as interpreters when you are required to sign your consent form. You should contact the Endoscopy Unit who will arrange for an interpreter to be present.
During the test
You will not have to undress but you must remove dentures, glasses or contact lenses and loosen tight clothing around the neck.
In the examination room you will be made comfortable on the couch resting on your left side. A nurse will stay with you throughout the procedure. To keep your mouth slightly apart, a plastic mouthpiece will be put gently between your teeth. When the person doing the test passes the endoscope into your stomach it will not cause pain, nor will it interfere with your breathing. The whole examination usually takes between 20 – 30 minutes.
Throat spray
This procedure is usually carried out using a combination of throat spray, which will be applied to the back of the throat to numb it, and sedation. This procedure can be carried out with throat spray alone but because the ultrasound scope is bigger than a standard scope, and the procedure lasts longer, it is usually recommended that sedation is given as well. The procedure can be done with throat spray alone but may be uncomfortable. With throat spray alone you are fully conscious and aware, and you can go home unaccompanied almost immediately after the procedure. You are permitted to drive and carry on your day as normal.
You will not be able to have anything to eat or drink for about an hour, until the effects of the spray have worn off. After this you will be able to eat and drink normally.
Sedation and oxygen
The procedure is normally done with sedation. If you have sedation it will be given through a small needle in the back of your hand or in your arm. Sedation will make you slightly drowsy and relaxed but not unconscious. You will be in a state called co-operative sedation. This means that although drowsy you will still hear what is said to you and there will be able to following simple instructions during the procedure.
You will be given oxygen through small tubes placed gently in your nostrils or through the plastic guard in your mouth. A clip will be attached to a finger or ear-lobe so that the levels of oxygen in the blood can be monitored and your blood pressure may also be measured automatically during the procedure using a small cuff around your arm.
Going home after you have received sedation
After the test you will remain in the unit to rest for about an hour. It is essential that a responsible adult comes to pick you up from the unit and accompanies you home by car or taxi – public transport is not suitable. Please note the unit closes at 18:00. Your relative/friend should arrive no later than 17:30 to collect you.
When you arrive home, it is important to rest quietly for the remainder of the day, with someone to look after you for 12 hours. It is advisable to have the following day off work but in any event for the first 24 hours following sedation do not:
- drive a car
- drink alcohol
- take sleeping tablets
- operate any machinery or electrical items – even a kettle
- sign any legally binding documents
- work at heights (including climbing ladders or onto chairs)
Sedation can impair your reflexes and judgement.
When will I know the results?
Before discharge from the unit, the nurse who has been looking after you will be able to give you a brief outline of the test results. If a biopsy has been done, the laboratory results will take longer, about four to six weeks. You will be given a copy of the report to take home with you.
The nurse will advise you to discuss the details of the results and any necessary treatment with your GP or hospital specialist. If you have any questions about the test, please contact the unit where you will be having your Endoscopic Ultrasound.
Last reviewed: 22 April 2024
