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