GI Endoscopy

Question 1

Types of Endoscopy

Answer 1

Esophagogastroduodenoscopy (EGD)

Endoscopic Ultrasound (EUS)

Flexible Sigmoidoscopy

Colonoscopy

Endoscopic Retrograde Cholangiopancreatography (ERCP)

Small Bowel Video Capsule

Question 2

Other names for Esophagogastroduodenoscopy

Answer 2

EGD

Gastroscopy

Upper endoscopy

Question 3

EGD Indications

Answer 3

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

Question 4

EGD Preparation

Answer 4

NPO X 4h

Usually don’t need to hold anticoagulation

Question 5

EGD Procedure

Answer 5

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

Question 6

EGD Risks

Answer 6

Adverse reaction to conscious sedation

Aspiration of stomach contents

Perforation (more often when using therapeutically)

Bleeding at bx site

Question 7

Schatzski’s Ring

Answer 7

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

Question 8

Conditions you may see on EGD

Answer 8

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

Question 9

Endoscopic US Therapeutic and Diagnostic Indications

Answer 9

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

Question 10

EUS Prep, Procedure, Risks

Answer 10

Prep: NPO X 4h

Procedure and Risks same as EGD

Question 11

Sigmoidoscopy

Answer 11

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

Question 12

Colonoscopy: Diagnostic and Therapeutic Indicaitons

Answer 12

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

Question 13

Colonoscopy Prep

Answer 13

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

Question 14

Colonoscopy Risks

Answer 14

Conscious sedation

Perforation

Bleeding at bx or polyp site

Splenic rupture

Question 15

Colonoscopy Procedure

Answer 15

IV conscious sedation

Lay on left side

Scope advanced to cecum or terminal

“Work” is done on the way out

~20-30min

Question 16

ERCP

Answer 16

Endoscopic Retrograde Cholangiopancreatography

Question 17

ERCP General Description

Answer 17

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

Question 18

ERCP Indicaitons

Answer 18

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

Question 19

ERCP Preparation and Procedure

Answer 19

Preparation: NPO X 4h, hold anticoagulation if suspect intervention

Procedure: performed in radiology; pt lies prone, oral esophageal intubation (11cm)

~30 minutes

Question 20

ERCP Risks

Answer 20

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

Question 21

Small Bowel Video Capsule

Answer 21

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

Question 22

Indications and Prep for Small Bowel Video Capsule

Answer 22

Indications:

• Obscure GI bleeding
• Crohn’s
• Abnormal imaging

Prep:

• Clear liquids 24h before exam
• NPO after MN
• No iron 7 days before exam