Diagnostic bedside EUS in the intensive care unit: a single-center experience

Published:December 06, 2012DOI:


      The knowledge of bedside diagnostic EUS in critically ill patients is limited.


      To investigate the indications, feasibility, safety, and clinical utility of diagnostic EUS in the intensive care unit (ICU).




      Tertiary-care referral teaching hospital.


      All consecutive patients who had EUS done in the ICU within a 6-year period.


      Bedside EUS and EUS-guided FNA.

      Main Outcome Measurements

      EUS indications, complications, and impact on management.


      A total of 64 EUS procedures were performed in 63 patients (38 men, 25 women; age range 27-78 years); 1 patient underwent 2 separate EUS procedures. EUS was performed while the patients were mechanically ventilated in 70% (45/64) of cases. Indications for EUS included jaundice (n = 24), mass of unknown etiology (n = 25), unexplained pancreatitis (n = 7), and staging of known cancer (n = 3). In 5 cases, EUS was used as an alternative to other imaging modalities because of morbid obesity (n = 3) or contraindication to intravenous contrast material (n = 2). Complications included reversible oxygen desaturation (n = 4), nonsustained ventricular tachycardia (n = 1), and transient hypotension (n = 1). Overall, EUS influenced management in 97% (62/64) of cases.


      Retrospective, single-center study.


      ICU-based EUS can be performed with few intraprocedural complications and can be a valuable diagnostic modality in the ICU setting. It appears to be particularly useful for determining the etiology of jaundice, masses of unknown etiology, and pancreatitis. It may have particular value as a diagnostic technique on selected patients with unstaged cancer and when morbid obesity or the inability to use intravenous contrast material precludes the use of other imaging modalities in the critically ill patient.


      ASA (American Society of Anesthesiologists Physical Status Classification System), EUS-FNA (EUS-guided FNA), ICU (intensive care unit), MRI (magnetic resonance imaging)
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        • Kim B.C.
        • Cheon J.H.
        • Kim T.I.
        • et al.
        Risk factors and the role of bedside colonoscopy for lower gastrointestinal hemorrhage in critically ill patients.
        Hepato-gastroenterology. 2008; 55: 2108-2111
        • Lee Y.C.
        • Wang H.P.
        • Wu M.S.
        • et al.
        Urgent bedside endoscopy for clinically significant upper gastrointestinal hemorrhage after admission to the intensive care unit.
        Intensive Care Med. 2003; 29: 1723-1728
        • Ramirez F.C.
        • McIntosh A.S.
        • Dennert B.
        • et al.
        Emergency endoscopic retrograde cholangiopancreatography in critically ill patients.
        Gastrointest Endosc. 1998; 47: 368-371
        • Fritscher-Ravens A.
        • Schirrow L.
        • Pothmann W.
        • et al.
        Critical care transesophageal endosonography and guided fine-needle aspiration for diagnosis and management of posterior mediastinitis.
        Critical Care Med. 2003; 31: 126-132
        • Fritscher-Ravens A.
        • Sriram P.V.
        • Pothman W.P.
        • et al.
        Bedside endosonography and endosonography-guided fine-needle aspiration in critically ill patients: a way out of the deadlock?.
        Endoscopy. 2000; 32: 425-427
        • Varadarajulu S.
        • Eloubeidi M.A.
        • Wilcox C.M.
        The concept of bedside EUS.
        Gastrointest Endosc. 2008; 67: 1180-1184
        • Mohamadnejad M.
        • Leblanc J.K.
        • Sherman S.
        • et al.
        Bedside endoscopic ultrasound in critically ill patients.
        Diagn Ther Endosc. 2011; 2011: 529791
        • Tsendsuren T.
        • Jun S.M.
        • Mian X.H.
        Usefulness of endoscopic ultrasonography in preoperative TNM staging of gastric cancer.
        World J Gastroenterol. 2006; 12: 43-47
        • Power D.G.
        • Schattner M.A.
        • Gerdes H.
        • et al.
        Endoscopic ultrasound can improve the selection for laparoscopy in patients with localized gastric cancer.
        J Am Coll Surg. 2009; 208: 173-178
        • Gonzalez-Moreno S.
        • Gonzalez-Bayon L.
        • Ortega-Perez G.
        • et al.
        Imaging of peritoneal carcinomatosis.
        Cancer J (Sudbury, Mass). 2009; 15: 184-189
        • Melamed R.
        • Sprenkle M.D.
        • Ulstad V.K.
        • et al.
        Assessment of left ventricular function by intensivists using hand-held echocardiography.
        Chest. 2009; 135: 1416-1420
        • Porembka D.T.
        Importance of transesophageal echocardiography in the critically ill and injured patient.
        Crit Care Med. 2007; 35: S414-S430
        • Beaulieu Y.
        • Marik P.E.
        Bedside ultrasonography in the ICU: part 2.
        Chest. 2005; 128: 1766-1781
        • Beaulieu Y.
        • Marik P.E.
        Bedside ultrasonography in the ICU: part 1.
        Chest. 2005; 128: 881-895
        • Bansal V.
        • Schuchert V.D.
        Jaundice in the intensive care unit.
        Surg Clin N Am. 2006; 86: 1495-1502
        • Sugiyama M.
        • Atomi Y.
        Endoscopic ultrasonography for diagnosing choledocholithiasis: a prospective comparative study with ultrasonography and computed tomography.
        Gastrointest Endosc. 1997; 45: 143-146
        • Azoulay E.
        • Moreau D.
        • Alberti C.
        • et al.
        Predictors of short-term mortality in critically ill patients with solid malignancies.
        Intensive Care Med. 2000; 26: 1817-1823
        • Nathens A.B.
        • Curtis J.R.
        • Beale R.J.
        • et al.
        Management of the critically ill patient with severe acute pancreatitis.
        Crit Care Med. 2004; 32: 2524-2536
        • Sanjay P.
        • Yeeting S.
        • Whigham C.
        • et al.
        Management guidelines for gallstone pancreatitis.
        JOP. 2009; 10: 43-47
        • Chak A.
        • Hawes R.H.
        • Cooper G.S.
        • et al.
        Prospective assessment of the utility of EUS in the evaluation of gallstone pancreatitis.
        Gastrointest Endosc. 1999; 49: 599-604
        • Liu C.L.
        • Lo C.M.
        • Chan J.K.
        • et al.
        Detection of choledocholithiasis by EUS in acute pancreatitis: a prospective evaluation in 100 consecutive patients.
        Gastrointest Endosc. 2001; 54: 325-330
        • Dye C.E.
        • Waxman I.
        Endoscopic ultrasound.
        Gastroenterol Clin N Am. 2002; 31: 863-879
        • Hogue Jr, C.W.
        • Stearns J.D.
        • Colantuoni E.
        • et al.
        The impact of obesity on outcomes after critical illness: a meta-analysis.
        Intensive Care Med. 2009; 35: 1152-1170
        • Uppot R.N.
        • Sahani D.V.
        • Hahn P.F.
        • et al.
        Impact of obesity on medical imaging and image-guided intervention.
        AJR Am J Roentgenol. 2007; 188: 433-440
        • Hasebroock K.M.
        • Serkova N.J.
        Toxicity of MRI and CT contrast agents.
        Expert opinion on drug metabolism & toxicology. 2009; 5: 403-416
        • Sotoudehmanesh R.
        • Hedayat A.
        • Shirazian N.
        • et al.
        Endoscopic ultrasonography (EUS) in the localization of insulinoma.
        Endocrine. 2007; 31: 238-241