The concept of bedside EUS

Abstract

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. To evaluate the concept of bedside EUS and assess its impact on patient management. A prospective study. A tertiary-referral center. Patients included those with pancreaticobiliary and thoracic disorders who required EUS but who were clinically unstable to be evaluated in the endoscopy suite. 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. 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. 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). Small number of patients; a single endosonographer. Bedside EUS is technically feasible, safe, facilitates both diagnosis and therapy, and enables the clinical management of patients who are critically ill.