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

Background: Although there is a large body of data on the accuracy of endos copic ultrasonography (EUS) in the diagnosis and staging of various gastroe nterological disorders, little has been published on the influence of EUS i n the management of patients. Data on the performance of EUS and patient ac ceptance are also sparse. Methods: During a 10-month period, all consecutive EUS examinations were ca tegorized by the examiner according to the appropriateness of the indicatio ns. Prior examinations, performance of EUS (duration, premedication, compli cations), and patient acceptance (assessed using a questionnaire by an inde pendent 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 "pot entially useful" (categories 1 to 3) in 81% of cases. The referring physici ans replied that EUS had provided useful additional information in 55% of c ases; the EUS findings prompted further tests in 22% and made further exami nations 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 range d from a mean of 8.1 minutes (esophageal indications) to 18.9 minutes (bili ary 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 wit h the same level of sedation. Conclusions: EUS is a safe examination that can be carried out within a rea sonable 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.