What is EUS?

Endoscopic Ultrasound (EUS) puts an ultrasound probe on the tip of an endoscope, so the scan is done from inside the digestive tract, from within the stomach and the first part of the small intestine, only millimetres from the liver, bile ducts and pancreas. Because there is no skin, fat or bowel gas in the way, EUS produces exceptionally detailed close-up images of these organs and can guide a needle into them with great precision. It is done under sedation, much like a gastroscopy.

Why it matters in a liver practice

EUS has grown from a diagnostic scan into a versatile tool that overlaps directly with hepatology:

EUS-guided liver biopsy: the probe can guide a needle into both the left and right lobes of the liver from within the gut. For selected patients this offers good-quality tissue with a different, sometimes gentler, access route than the percutaneous approach.
Assessing the bile ducts and pancreas: EUS is one of the best tests for finding small bile-duct stones, characterising blockages and masses, and sampling suspicious areas.
EUS-guided treatment of gastric varices: EUS lets the endoscopist see a varix and the vessel feeding it directly, and deliver treatment (glue, coils, or both) under image guidance.
Measuring portal pressure: in specialised centres, EUS can even be used to measure the pressure gradient across the liver, the same information a conventional HVPG study gives.

How it’s done

After sedation, the EUS endoscope is passed through the mouth into the stomach and duodenum, just as in a normal upper endoscopy. The ultrasound images are studied, and if a biopsy or treatment is planned, a fine needle is passed down the scope and guided in real time to its target. Most EUS procedures are day-care.

Risks

Diagnostic EUS is very safe, with risks similar to a routine gastroscopy. When a needle is used, for biopsy or to treat varices, there is a small added risk of bleeding or infection, managed with the usual precautions.

Dr Kalal’s role

EUS is an advanced-endoscopy procedure. Dr Kalal identifies the patients in whom EUS will change management and directs the work-up, performing or coordinating the EUS with the therapeutic-endoscopy team and integrating the findings into the overall liver plan.