Endoscopic ultrasound procedure

This is an automatically translated article.

The article is professionally consulted by MSc, BS. Dang Manh Cuong - Radiologist - Radiology Department - Vinmec Central Park International General Hospital. The doctor has over 18 years of experience in the field of ultrasound - diagnostic imaging.

1. What is Endoscopic Ultrasound?

Endoscopic ultrasound is a technique that combines both endoscopic and ultrasound procedures at the same time, in which the ultrasound probe is applied to the lesions arising when the doctor needs to explore through the endoscope such as: Injury to the wall of the esophagus, stomach, intestines, liver, pancreas and biliary tract.
Endoscopic ultrasound is considered as one of the most important achievements in the digestive field in recent years.
Endoscopic ultrasound differs from conventional flexible bronchoscopes in that: Conventional flexible bronchoscopy helps doctors to observe and evaluate the surface of the patient's gastrointestinal tract, but it does not allow identification of the invasion of lesions as well as abnormalities located below the epithelial lining. Therefore, with the endoscopic method, the technique has attached to the end of the endoscope a probe that can conduct ultrasound examination from within the gastrointestinal tract.

2. When is the patient indicated for endoscopic ultrasound?

2.1 Diagnose abnormalities in the submucosa of the gastrointestinal tract Differentiate a lesion from the gastrointestinal tract wall or from the outside Assess the size and structure of the tumor Assess the size of the gastric mucosal folds Diagnose varices in the esophagus and stomach Staging of gastrointestinal tumors Diagnose some pathologies of the pancreas and biliary tract Evaluate the stages of cancer Determine the location of endocrine tumors Find stones and worms in the common bile duct 2.2 Other indications Evaluation of treatment outcomes for varices Inflammatory bowel disease Esophageal motility pathology Benign healing ulcer Assessment of ulcer bleeding risk Pseudocyst drainage pancreatitis under the guidance of SANS Chronic pancreatitis Fine needle aspiration under the guidance of SANS Diagnosis and classification of cancer Destruction of the visceral plexus for pain relief Esophageal spasms .

3. Instruments to prepare for endoscopic ultrasound indication

Endoscopic ultrasound machine, suction machine, light source, monitor, mouthpiece Pulse monitor, blood pressure monitor, spO2 Medication Seduxen, buscopan, midazolam, fentanyl or propofol 01 gastroenterologist, 1 nurse, 1 Anesthesiologist Endoscopic ultrasound machine used in gastrointestinal diagnosis with Radian transducer with frequencies of 7.5MHz, 10MHz, 12MHz.

4. Endoscopic ultrasound procedure

Before performing ultrasound endoscopy, the patient is required to fast for 6 hours before the procedure, the patient will be seen by the anesthesiologist first to explain the benefits and risks of the procedure and agree.
Give the patient an anti-foam Simethicone 30 minutes before the test.
Steps to take
The nurse needs to prepare and check the scope. After anesthesia, place the patient on the left side and place the mouthpiece between the two dental arches. Anesthesia method: Use anesthesia with seduxen or midazolam/fentanyl for intravenous or endotracheal anesthesia depending on the case. Must monitor pulse, blood pressure, temperature, breathing rate.

Insert the light bulb through the esophagus into the stomach. When the antrum and pylorus are seen, the machine is inserted into the duodenal bulb and down to the 2nd part of the duodenum. Note that in the process of inserting the endoscope, do not use the ultrasonic button. The endoscopic process to identify the lesion started from the most distal area such as the descending duodenum. When gently withdrawing the machine, the ultrasound images are considered as landmarks, and the organs around the stomach such as the liver, pancreas, and spleen can be observed. In the esophagus, the descending segments of the aortic arch and the left atrium are considered anatomically oriented landmarks. Examining only abnormalities in the esophagus and stomach does not need to bring the machine down to the pylorus and duodenum. Probing the SANS of the upper gastrointestinal tract can be done by: Directly applying the probe to the gastrointestinal mucosa under the guidance of the endoscope. Using a balloon that can push water around the transducer will create a super-warm window for the best view of the stomach wall and surrounding organs. After the endoscopy is done, the patient should be taken to the recovery room to rest, avoid being shocked due to the effects of anesthesia, and let the nurse monitor after the endoscopy to avoid complications. symptoms after endoscopy. However, endoscopic ultrasound is only a safe exploration method, so the complication rate is very low. Vinmec International General Hospital is one of the leading international hospitals in Vietnam, always updating regularly with new technical methods, technology and machinery to improve service for medical examination and treatment. Endoscopic ultrasound has also been used by hospital doctors in digestive clinics.

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