Table 1.
Required elements of EUS reporting
Preprocedural |
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Date and time of procedure |
Type of procedure |
Type of EUS probe |
Linear or radial |
Name of primary endoscopist |
Name(s) of assistants/trainees |
Patient demographics and comorbidities |
Age |
Sex |
Past medical history |
Relevant surgical, family, and social history |
Patient home medications |
Including modifications to medications for the procedure |
Other preendoscopic medications |
Need for antibiotic prophylaxis |
Indication for the procedure |
Relevant preprocedural investigations |
Blood work, imaging, and prior endoscopy |
Documentation of informed consent |
Type and dose of sedation |
Anesthetist |
General or conscious sedation |
Preprocedural preparation |
Duration of NPO |
Bowel preparation |
Intraprocedural |
Adequacy and extent of examination |
Description |
Relevant landmarks |
Lesion(s) |
Size |
Sonographic characteristics |
Pertinent positives/negatives |
Tumor staging (TNM) |
Sampling method and sample quality |
Needle type and gauge |
Number of passes |
Tissue acquisition technique |
Presence of rapid on-site evaluation |
Sample characteristics |
Patient comfort |
Intraprocedural adverse events |
Endoscopic Interventions |
Postprocedural |
Diagnosis and relevant findings |
Management and follow-up recommendations |
Clear list of action items with timing, responsible provider, and rationale |
Recommendations regarding the resumption of antithrombotic |
Indication of provision of postprocedural information to patient/family |
Plan for sharing of pathology results when available |
TNM: Tumor, node, metastatic spread; NPO: Nil per os