GI Endoscopy Flashcards
Types of Endoscopy
Esophagogastroduodenoscopy (EGD)
Endoscopic Ultrasound (EUS)
Flexible Sigmoidoscopy
Colonoscopy
Endoscopic Retrograde Cholangiopancreatography (ERCP)
Small Bowel Video Capsule
Other names for Esophagogastroduodenoscopy
EGD
Gastroscopy
Upper endoscopy
EGD Indications
Diagnostic Indications
- Long standing GERD (>5 years)
- Dysphagia
- Anemia
- Epigastic abdominal pain
- Recurrent or chronic N/V
- F/U on AXR images
- Screening for esophageal varicies and sprue
**Therapeutic Indications: **
- GI bleeding (cauterize, inject epi, clipping)
- Esophageal variceal banding
- Esophageal or pyloric channel dilation
- Bx abnormal tissue
- Stent placement
- Small bowel capsule placement
EGD Preparation
NPO X 4h
Usually don’t need to hold anticoagulation
EGD Procedure
IV conscious sedation
Lay on left side
Oral-esophageal intubation (tube 7mm)
Gagging is normal
If indicated, bx is taken
Dilation performed if appropriate and consent obtained
EGD Risks
Adverse reaction to conscious sedation
Aspiration of stomach contents
Perforation (more often when using therapeutically)
Bleeding at bx site
Schatzski’s Ring
Often present with dysphagia
Benign stricture in distal esophagus
No clear etiology (associated with GERD, old age, and hiatal hernia)
Tx: dilation or if severe surgical repair
Conditions you may see on EGD
Esophagitis from GERD
Schatzki’s Ring
Esophageal Varices–can also therapeutically band using EGD
Barrett’s Esophagus
Esophageal Carcinoma
- If tumor at GE junction more likely adenocarcinoma due to GERD/Barrett’s
- Proximal tumor more likely squamous cell carcinoma from tobacco and EtOH use
Gastritis and Duodenitis
Peptic Ulcer Disease
Endoscopic US Therapeutic and Diagnostic Indications
Diagnostic
- Esophageal and pancreatic CA bx and staging
- Mediastinal mass bx
- Porta-hepatis and periduodenal assessment and bx
- Evaluating chronic pancreatitis and pancreatic cysts
- Evaluating gallbladder, bile and pancreatic ducts for stones and liver lesions
- Rectal and peri-rectal lesion evaluation
Therapeutic:
- Drain pancreatic pseudocysts
- Celiac plexus nerve block
EUS Prep, Procedure, Risks
Prep: NPO X 4h
Procedure and Risks same as EGD
Sigmoidoscopy
Colon exam from sigmoid to descending colon
Typically no sedation given–pts can drive home
Risks: perforation, abdominal cramping, bloating, bleeding
Indications: evaluation diarrhea, proctitis, rectal pain, and abnormal imaging studies
CI: acute peritonitis or diverticulitis, toxic megacolon, recent bowel surgery
Prep: Clear liquids day before procedure; two enemas day of procedure; stop anticoags 3-5 days before procedure
Colonoscopy: Diagnostic and Therapeutic Indicaitons
Diagnostic:
- Iron deficiency anemia
- GI bleeding
- Abdominal pain
- Abnormal CT or BE
- IBD
- CRC screening
- Diarrhea
Therapeutic:
- Control of GI bleeding (cautery, injection, clipping)
- Dilation of stricture
- Placement of stent
- Colonic decompression
Colonoscopy Prep
Clear liquids 24h before prep
Polyethylene glycol with sodium bicarb/sodium chloride/potassium - GoLytely FOUR LITERS
Polyethylene glycol (Miralax) with gatorade
NPO after midnight
Hold ASA, NSAIDS, coumadin
Colonoscopy Risks
Conscious sedation
Perforation
Bleeding at bx or polyp site
Splenic rupture
Colonoscopy Procedure
IV conscious sedation
Lay on left side
Scope advanced to cecum or terminal
“Work” is done on the way out
~20-30min
ERCP
Endoscopic Retrograde Cholangiopancreatography
ERCP General Description
Allows for: tissue sampling, spinchter of oddi monometry, and therapeutic procedures.
Can see the biliary system including common bile, intrahepatic, and pancreatic ducts. Endoscopic exam performed under fluoro
ERCP Indicaitons
Diagnostic:
- Pancreatitis:
- Fistulae
- Tumors (obstructive jaundice or suspicious mass on other imaging)
- Preoperative evaluation for chornic pancreatitis or pseudocyst
- Miscellaneous: unexplained weight loss, steatorrhea, SOD manometry
Therapeutic:
- Remove stones causing pancreatitis
- Resection of papillary tumor
- Psuedocyst of pancreas - cyst gastrostomy/duodenostomy
- Bile duct or pancreatic duct obstruction–stenting
ERCP Preparation and Procedure
Preparation: NPO X 4h, hold anticoagulation if suspect intervention
Procedure: performed in radiology; pt lies prone, oral esophageal intubation (11cm)
~30 minutes
ERCP Risks
Riskiest of all endoscopic procedures
Pancreatitis
- repeated cannulation attempts
- trauma to ampulla
- underlying condition of pancreas
Infection
Bleeding
Retroperitoneal perforation
Drug rxns
Injury to esophagus, stomach, duodenum
Small Bowel Video Capsule
Caution use with PPM and AICD or hx of bowel obstruction and surgery
Performed after EGD and colonoscopy.
Occassionally capsule must be placed with endoscope
Procedure: Camera about size of large multivitamin. Image sensor on belt with 7-8h battery life. Capsule not collected in stool.
Limitations: Can’t obtain biopsy. Difficulty identifying exact location of findings. Requires scrupulous bowel cleansing. Takes a long time to analyze video
Indications and Prep for Small Bowel Video Capsule
Indications:
- Obscure GI bleeding
- Crohn’s
- Abnormal imaging
Prep:
- Clear liquids 24h before exam
- NPO after MN
- No iron 7 days before exam
