Performance, patient acceptance, appropriateness of indications and potential influence on outcome of EUS: a prospective study in 397 consecutive patients

Abstract

Background: Although there is a large body of data on the accuracy of endoscopic ultrasonography (EUS) in the diagnosis and staging of various gastroenterological disorders, little has been published on the influence of EUS in the management of patients. Data on the performance of EUS and patient acceptance are also sparse.

Methods: During a 10-month period, all consecutive EUS examinations were categorized by the examiner according to the appropriateness of the indications. Prior examinations, performance of EUS (duration, premedication, complications), and patient acceptance (assessed using a questionnaire by an independent investigator) were recorded. A mean of 2 months after the procedure, referring physicians were asked about the extent to which the EUS results had influenced their further diagnostic and therapeutic approach.

Results: A total of 397 patients were included; they were referred for EUS after a mean of 1. 8 specific tests had been performed. The appropriateness of the indications for EUS was categorized as "classic," "useful," and "potentially useful" (categories 1 to 3) in 81% of cases. The referring physicians replied that EUS had provided useful additional information in 55% of cases; the EUS findings prompted further tests in 22% and made further examinations unnecessary in 30%. A change in therapy was believed to be directly due to EUS in only 6% of cases. The duration of the EUS examinations ranged from a mean of 8.1 minutes (esophageal indications) to 18.9 minutes (biliary indications). There were no complications. In patients who were able to remember the EUS examination (42%), 90% found it tolerable, and 83% of all the patients interviewed were willing to have the examination repeated with the same level of sedation.

Conclusions: EUS is a safe examination that can be carried out within a reasonable time frame by experienced examiners and without significant patient discomfort when performed under conscious sedation. With regard to patient management, EUS mainly influences further diagnostic tests.