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. 2021 Mar 2;10(2):84–92. doi: 10.4103/EUS-D-20-00234

Supplementary Appendix 3.

Sample EUS report template

Preprocedural Patient name and medical record number
Patient date of birth
Date of procedure
Procedure type and indication
Primary endoscopist name (and assistant/trainee if applicable):
Preoperative diagnosis
Postoperative diagnosis
Clinical history
 Reason for referral
 Brief clinical summary of primary indication for EUS
 Summary of relevant preprocedural investigations
 List of pertinent comorbid conditions relevant to case and potentially impacting procedural success/yield
 Highlight key medications and date if held
Anesthesia
 Type of agents (topical, intravenous) and dosage
 Practitioner administering anesthesia
Preprocedural prophylaxis
 Type of antibiotic, dosage, and length of course if administered
Pre-procedural preparation
 Duration of NPO prior to procedure
 Bowel preparation as appropriate for procedure
Intra-procedural Procedural description
 Document the type and model of scope used
 Description of landmarks and relevant characteristics
 Clear characterization of principle finding for procedure
  If lesion present description of location, shape, size, invasion, echofeatures, and vascularity
  Any regional lymphadenopathy
 Type of equipment used and model for sampling if applicable
  Needle type and gauge, tissue acquisition technique, number of passes
  Impression on quality of sample
 Quality of bowel preparation if applicable
Adverse events
 Any intraprocedural adverse events and subsequent management
Patient comfort
Postprocedural Summary
 Summary of the major findings during examination, sampling or therapeutic intervention if completed
 Overall impression and diagnosis
 Patients comfort and tolerance during the procedure
Plan
 Timing for resuming anticoagulation if held
 Sharing of pathology results
 Next steps in management and follow-up providers listed
 Communicating the procedure and pathology results with the patient

NPO: Nil per os