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Gastrointest Endosc. 2008 Jun;67(7):1180-4. doi: 10.1016/j.gie.2008.02.005. Epub 2008 Apr 18.

The concept of bedside EUS.

Author information

1
Division of Gastroenterology-Hepatology, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama 35294, USA.

Abstract

BACKGROUND:

Although the role of bedside endoscopy for the provision of emergent diagnosis and therapy is well known, the concept of bedside EUS requires further validation.

OBJECTIVE:

To evaluate the concept of bedside EUS and assess its impact on patient management.

DESIGN:

A prospective study.

SETTING:

A tertiary-referral center.

PATIENTS:

Patients included those with pancreaticobiliary and thoracic disorders who required EUS but who were clinically unstable to be evaluated in the endoscopy suite.

INTERVENTIONS:

All procedures were performed by one endosonographer at the patient's bedside by using an EUS cart that was equipped with a therapeutic curvilinear echoendoscope.

MAIN OUTCOME MEASUREMENTS:

To evaluate the technical feasibility, safety, and impact of bedside EUS in the clinical management of patients. EUS was considered to have a significant impact if a new diagnosis was established and/or if the findings altered subsequent management.

RESULTS:

Within a 3-month period, 6 patients (4 men; median age 56 years; American Society of Anesthesiologists class III/IV) were evaluated in the intensive care unit by using the mobile EUS cart. Procedural indications were the following: drainage of symptomatic pseudocyst (n = 2), evaluate the cause of cholangitis (n = 2), diagnose and treat a suspected postoperative (distal esophagectomy) fluid collection (n = 1), and provide tissue diagnosis in one patient with a pancreatic-head mass, who presented with intrahepatic bleeding. The procedure was technically successful in all 6 patients (100%), and no complications were encountered. Bedside EUS established a diagnosis of choledocholithiasis (n = 1), mediastinal abscess (n = 1), and pancreatic abscess (n = 1) in 3 patients, and ruled out the presence of choledocholithiasis (n = 1) and pancreatic pseudocyst (n = 1) in 2 other patients. Also, by using bedside EUS, transmural drainage of a pancreatic pseudocyst and mediastinal abscess was successfully undertaken in 2 patients. Bedside EUS had an impact on management in all 6 patients (100%): established a new diagnosis (n = 3), precluded the need for an ERCP and/or other interventions (n = 2), and enabled focused endotherapy (n = 3).

LIMITATIONS:

Small number of patients; a single endosonographer.

CONCLUSIONS:

Bedside EUS is technically feasible, safe, facilitates both diagnosis and therapy, and enables the clinical management of patients who are critically ill.

PMID:
18423463
DOI:
10.1016/j.gie.2008.02.005
[Indexed for MEDLINE]

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