Endoscopic ultrasound, from the inside.

In endoscopic ultrasound, a small ultrasound probe sits at the tip of an endoscope. This allows the stomach wall, pancreas and bile ducts to be assessed at close range and tissue samples to be taken if needed – under light sedation.

  • No X-rays
  • Tissue sampling possible
  • German statutory insurance at the Bürgerspital

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  • 15–45minutes, longer if a tissue sample is taken
  • Sedationlight sleep induced by medication through a vein
  • Outpatientor inpatient, depending on the reason and the findings
  • Fastingno food from six hours beforehand
  • 12–24hours afterwards without driving yourself

Approximate figures from the clinics and guidelines. The team will discuss the exact procedure with you beforehand.

The examination

Closer than from outside.

Endoscopic ultrasound combines two procedures: an endoscopy and an ultrasound scan. The instrument resembles the endoscope used for a gastroscopy but is slightly thicker and carries a small ultrasound probe at its tip. It is passed through the mouth into the oesophagus, stomach and duodenum – or through the anus for questions concerning the rectum.

The advantage lies in proximity. With ultrasound through the abdominal wall, air in the bowel and the tissue in between get in the way; deep-lying organs such as the pancreas are often only partly visible. From the inside, only a few millimetres separate the probe from the stomach wall, pancreas, bile duct and lymph nodes. The image shows the individual layers of the wall and even small changes – without X-rays.

Common reasons include a bulge beneath the lining noticed during a gastroscopy, cysts or nodules in the pancreas, and a suspected stone in the bile duct when conventional ultrasound does not provide clarity. After an inflammation of the pancreas with no apparent cause, endoscopic ultrasound looks for tiny stones. With tumours of the oesophagus, stomach or rectum, the examination shows how deep they reach into the wall and whether nearby lymph nodes are affected; further treatment depends on this.

If a finding remains unclear, a fine needle can be guided through the wall into the abnormal area under ultrasound guidance. This fine-needle aspiration obtains tissue or fluid for the laboratory, without an incision and by a short route. Endoscopic ultrasound differs from ERCP in its aim: it is mainly used for diagnosis, whereas ERCP treats the bile duct. If endoscopic ultrasound finds a bile duct stone, ERCP can often follow immediately.

The benefits

What endoscopic ultrasound can do.

Detect

From a distance of just a few millimetres, the ultrasound shows the layers of the stomach and bowel wall and organs such as the pancreas – including small changes that remain hidden from outside.

Confirm

Guided by ultrasound, a fine needle passes through the wall into the abnormal area. In the laboratory, the tissue sample shows what it is.

Decide

The findings set the course: monitoring, endoscopic removal, surgery or preliminary treatment. If endoscopic ultrasound rules out a bile duct stone, it can spare you an ERCP.

The procedure

From referral to results.

Endoscopic ultrasound is usually a planned appointment, often following a referral from a GP or specialist practice. With acute symptoms, it takes place during a hospital stay.

  1. Preliminary consultation

    The specialist clarifies the question to be answered, reviews previous results and explains the procedure and risks. Please bring your referral, previous results and your current medication plan.

  2. Preparation

    On the day of the examination, you need to fast. Blood-thinning medication is discussed beforehand, especially if a tissue sample is planned – it is only stopped after consulting a doctor.

  3. Examination

    While you lie on your left side under light sedation, the endoscope is inserted through your mouth; breathing and circulation are continuously monitored. The examination is usually over after 15 to 45 minutes.

  4. Recovery

    After waking up, you remain under observation for a while. You may only go home accompanied.

  5. Results

    The doctor usually explains the ultrasound findings on the same day; the result of a tissue sample follows after a few days. Then the next steps are clear.

Statutory or private insurance

Who covers the costs.

Statutory health insurance

Covered by statutory insurance when indicated.

If endoscopic ultrasound is used to investigate symptoms or an abnormal finding, it is covered by German statutory health insurance. In Wertheim, patients with statutory insurance are examined at the Bürgerspital, which is approved as a hospital with a public healthcare mandate.

Please bring your health insurance card to the appointment and, if you have one, a referral from your GP or specialist.

Private insurance or self-pay

According to your policy or by agreement.

Private health insurers cover the medically necessary examination according to the terms of their policy. Privately insured and self-pay patients can also be examined at the Main-Tauber-Klinik, the private clinic under the same roof.

Self-pay patients clarify the costs with the clinic before the examination.

Specialists

Your doctors at a glance.

Endoscopic ultrasound is performed by specialists in internal medicine and gastroenterology. All three belong to the teams of both clinics in Wertheim.

  • Mamoon Al HamedSpecialist in Internal Medicine & GastroenterologyWertheim
  • Mohammad Al RashdanSpecialist in Internal Medicine & GastroenterologyWertheim
  • Dr. med. Barbara John, FEBGHSpecialist in Internal Medicine & GastroenterologyWertheim

Locations

Where treatment takes place.

Each clinic shows on its own website how the treatment works there.

Frequently asked questions

Good to know.

How does endoscopic ultrasound differ from an abdominal ultrasound?

In a conventional ultrasound, the probe rests on the abdominal wall. Air in the bowel and the tissue in between weaken the image, and deep-lying organs remain partly hidden. In endoscopic ultrasound, the probe lies in the stomach or duodenum right next to the organ – so the image is correspondingly finer.

How do I prepare?

The usual rule is no food for six hours beforehand, clear drinks often until shortly before – the team will tell you the exact times. If the rectum is examined, an enema is part of the preparation. Bring your medication plan and previous results, and arrange for someone to accompany you home.

Does endoscopic ultrasound hurt?

It takes place under light sedation, and most people notice little of it. Afterwards, the throat or abdomen may be irritated for a while, for example from air that is blown in for a better view. This usually settles quickly.

When will the result be available?

The doctor usually discusses the ultrasound findings as soon as you are awake again. A tissue sample is examined under the microscope in the laboratory, which takes a few days.

What are the risks of the examination?

Serious complications are rare. Possible risks include reactions to the sedative, which are quickly noticed thanks to continuous monitoring, and, rarely, an injury to the wall of the oesophagus, stomach or duodenum. After a tissue sample, bleeding and infection are possible; after a sample from the pancreas, inflammation of the organ is also possible.

Can I drive afterwards?

Not straight away. After sedation, your reactions and judgement remain impaired for a while. Depending on the medication, you should not drive, operate machinery or sign important documents for 12 to 24 hours – arrange to be collected.

Is treatment also given during endoscopic ultrasound?

It is mainly used for diagnosis. However, a fine needle can be used to obtain tissue or fluid, for example from a cyst. If a stone is found in the bile duct, an ERCP can often follow immediately, under the same sedation.

Does health insurance cover endoscopic ultrasound?

Yes, if it is medically indicated, for example to investigate a finding. Patients with statutory insurance are examined for this at Bürgerspital Wertheim; private insurers pay according to their policy, including for the examination at the Main-Tauber-Klinik.

Consultation

Personal consultation.

Describe your request – the right clinic will get back to you.

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