Endoscopic ultrasound for lung cancers

This test combines ultrasound and endoscopy. It helps your doctor to look through the wall of the food pipe (oesophagus) at the surrounding tissue. The main airway (windpipe) is close to the oesophagus.

An endoscopy is a test to look inside your body. Your doctor uses a long flexible tube called an endoscope. It has a tiny camera and light on the end. The endoscope also has an ultrasound probe at its tip. 

An ultrasound scan uses high frequency sound waves to create a picture of the inside of your body.

You normally have this test in the endoscopy unit at the hospital. It takes between 15 and 45 minutes, but you should expect to be in the hospital for a few hours.

You have an endoscopic ultrasound (EUS) with a local anaesthetic and light sedation .

Why do I need an endoscopic ultrasound?

An EUS can check whether lung cancer and mesothelioma has spread. It checks for signs of cancer in the lymph nodes in the centre of the chest close to the windpipe.

What do I need to do to prepare for an endoscopic ultrasound?

You usually have written information explaining how to prepare for your EUS. It’s important that you read and follow the instructions. There is usually a number to call if you have any questions.

You might have blood tests beforehand to check your blood levels and how well your blood clots.

Tell your doctor if you're taking medicines that changes how your blood clots. This includes:

• warfarin or heparin
• aspirin
• clopidogrel
• apixaban or rivaroxaban
• ticagrelor

Your doctor will tell you if you need to stop taking these or any other medicines for a while before your EUS. 

You can't eat or drink for some time before the test. The instructions may be different depending on the hospital where you have your test. Check your letter to find out when you need to stop eating and drinking. Contact the department in advance if this is a problem for you, for example, if you have diabetes.

What happens on the day?

Before the test

When you arrive at the endoscopy department the nurse takes some measurements. This includes your blood pressure, heart and breathing rate, your oxygen level and weight.

A doctor or a specialist nurse (endoscopist) does the test. First they will explain the procedure and ask you to sign a consent form. This is a good time to ask any questions you may have.

You may need to change into a hospital gown, or you might be able to stay in your own clothes. If you have false teeth you may need to remove them before the test.

Having a local anaesthetic with a light sedation

The nurse takes you to the test room. You have the procedure on a couch lying down on your left side.

You will have a sedative. This will help you to relax and can make you feel sleepy, but you will be able to answer questions. You have the sedative through a small tube into your vein (cannula).

The endoscopist will numb your throat using a local anaesthetic. They will either use a spray or a spray and gel. This can make you cough; your eyes may water and you may have a bitter taste in your mouth. You may feel like you can't swallow but you can. 

Your nurse puts a plastic guard in your mouth to protect your teeth from the endoscope.

You may have oxygen through a small plastic tube or sponge that sit just inside your nostril. They also put a clip on your finger to check your oxygen levels and heart rate.

During the test

The endoscopist puts the endoscope into your mouth and down your throat. This is a bit uncomfortable, and you might gag, but it doesn't last long. It shouldn’t hurt because you have had the local anaesthetic. You can breathe normally.

The endoscopist can see the images from the endoscope on a television screen. They look for anything abnormal and can take tissue samples (biopsies) through the endoscope. This shouldn’t be painful.

At the end of the test, your endoscopist gently removes the endoscope.

After the test

Afterwards, you'll feel sleepy. A nurse will monitor you until you are fully awake and recovered.

You won’t be able to eat or drink anything until the local anaesthetic wears off. This usually takes about an hour. This is because your throat is too numb to swallow safely at first.

The nurse will remove the cannula before you are ready to leave.

Your endoscopist will talk to you about how the test went. They will tell you if they took any biopsies and when to expect the results.

Going home

You can usually go home the same day. If you take blood thinners your endoscopist or nurse will tell you when to restart them. This is usually the next day. Someone should collect you from the hospital and stay with you overnight if you have had a sedative.

For 24 hours after having sedation, you shouldn't:

• drive
• drink alcohol
• operate heavy machinery
• sign any important documents

You need to take things easy for a day or so. You might have a sore throat for a couple of days.

Possible risks of EUS

An EUS is a very safe procedure. Your nurse tells you who to contact if you have any problems afterwards. Your doctors make sure the benefits of having an EUS outweigh the possible risks.

The possible risks include:

A sore throat

You might have a sore throat for up to 24 hours. Contact the hospital if you have severe pain in your throat, chest or tummy (abdomen).

Bleeding

There is a risk of bleeding from the biopsy site. This is usually a small amount and stops on its own. Rarely you may need a blood transfusion.

Small tear in the food pipe

There is a risk of a small tear (perforation) in the food pipe. This is rare. If it happened, you would need to stay in hospital and have antibiotics and possibly an operation to repair the tear.

Fluid going into your lungs

There is a very small risk of fluid going into your lungs from your mouth during the test. Your nurse uses a suction tube to remove most of the fluid from your mouth to reduce this risk.

Shortness of breath

A reaction to the sedative can cause breathing difficulties but this is rare. Your nurse checks your oxygen levels during the test. You have oxygen through a tube or sponge that fits into your nose.

Getting your results

You should get your results within 1 to 2 weeks, but it may take longer. Contact the doctor who arranged the test if you haven't heard anything after a couple of weeks.

Waiting for test results or for further tests can be very worrying. You might have contact details for a specialist nurse and you can contact them for information if you need to. It may help to talk to a close friend or relative about how you feel.