Name of the Procedure:

Esophagogastroduodenoscopy, flexible, transoral; with transendoscopic ultrasound-guided intramural or transmural fine needle aspiration/biopsy(s)

• Common Names: EGD with EUS-guided FNA/Biopsy, Endoscopic Ultrasound (EUS)-guided Biopsy

Summary

This procedure involves examining the esophagus, stomach, and duodenum using a flexible endoscope inserted through the mouth. An ultrasound probe attached to the endoscope allows for detailed imaging and guided fine needle aspiration or biopsy of tissue within or through the walls of these organs.

Purpose

The procedure is used to diagnose and evaluate conditions such as tumors, inflammation, or other abnormalities within the esophagus, stomach, or duodenum. The goal is to obtain tissue samples for further analysis to aid in diagnosis and treatment planning.

Indications

• Unexplained abdominal pain or discomfort
• Difficulty swallowing (dysphagia)
• Suspected gastrointestinal tumors or cancers
• Gastrointestinal bleeding
• Abnormal findings on prior imaging studies
• Weight loss without a known cause

Preparation

• Patients are usually required to fast for 6-8 hours before the procedure.
• Certain medications may need to be adjusted or paused, as instructed by the healthcare provider.
• Patients may need to arrange for someone to drive them home due to sedation.

Procedure Description

1. The patient is sedated or given anesthesia for comfort.
2. A flexible endoscope with an ultrasound probe is inserted through the mouth and guided through the esophagus, stomach, and duodenum.
3. Ultrasound images are generated to visualize abnormalities.
4. If needed, fine needle aspiration or biopsy is performed, guided by the ultrasound images.
5. Tissue samples are collected for pathological examination.
6. The endoscope is carefully withdrawn.

Duration

The procedure typically takes about 60 to 90 minutes.

Setting

The procedure is typically performed in a hospital endoscopy suite or an outpatient surgical center.

Personnel

• Gastroenterologist or endoscopist
• Endoscopy nurse
• Anesthesiologist or sedation nurse

Risks and Complications

• Sore throat or discomfort after the procedure
• Bleeding from the biopsy site
• Infection
• Perforation of the gastrointestinal tract
• Adverse reactions to sedation or anesthesia

Benefits

• Accurate diagnosis of gastrointestinal conditions
• Minimally invasive compared to surgical biopsy
• Helps in planning appropriate treatment options
• Immediate visualization of abnormalities during the procedure

Recovery

• Patients usually recover from sedation within a few hours.
• Mild sore throat and possible abdominal discomfort, which typically resolve quickly.
• Patients may need to follow a specific diet temporarily post-procedure.
• Follow-up appointments may be scheduled to discuss biopsy results.

Alternatives

• Traditional upper endoscopy without ultrasound guidance
• Imaging studies such as CT scan or MRI
• Surgical biopsy (more invasive)

## Pros and Cons of Alternatives:

• Non-invasive imaging may not provide sufficient detail or ability to biopsy.
• Surgical biopsies are more invasive and carry higher risks but may be needed if endoscopic methods are inconclusive.

Patient Experience

During the procedure, patients will be sedated and should not feel pain. Afterward, mild soreness in the throat and some abdominal discomfort may occur. These symptoms generally subside within a day or two. Pain management and other comfort measures will be provided as needed.