GI investigations pt.1 Flashcards
What are different endoscopic procedures used for GI investigations?
- Upper endoscopy (esophagogastroduodenoscopy)
- Colonoscopy
- Flexible sigmoidoscopy
- Small-Bowel endoscopy
- ENDOSCOPIC RETROGRADE
CHOLANGIOPANCREATOGRAPHY (ERCP) - ENDOSCOPIC
ULTRASOUND - NATURAL ORIFICE TRANSLUMINAL
ENDOSCOPIC SURGERY
What can an upper endoscopy visualize? What is it best for?
- Esophagus, stomach, and duodenum
- Best for assessing upper gastrointestinal mucosa
What can a colonoscopy visualize?
- Assesses the colon and distal ileum
- The cecum is reached in more than 95% of cases, and the terminal ileum can often be examined
Endoscopy procedure
- Sedation optional
- Pharynx may be sprayed with local anaesthetic before the endoscope is passed
- Nasal canula O2 delievery, monitor respirations and oximetry
- A flexible endoscope is passed through the mouth into the esophagus, stomach, and duodenum
- Continuous suction must be available to prevent aspiration
Pre-procedure patient preparation for upper GI endoscopy
- Stop PPIS 2wks preop
if possible (pathology-masking) - if on aspirin, clopidogrel, warfarin, or DOACS these need stopping only if therapeutic procedure
- Nil by mouth for 6h before
- Don’t drive for 24h if sedation is used
Upper GI endoscopy complications
Sore throat; amnesia, respiratory depression, or allergic reactions from sedation; perforation (<0.1%, higher in certain therapeutic indications); bleeding
Diagnostic indications for upper GI endoscopy
- Hematemesis/melena
- Dysphagia
- Dyspepsia (55yrs old + alarm symptoms or treatment refractory)
- Refractory vomiting
- Duodenal biopsy (gold standard test for celiac disease)
- Sample duodenal tissue/fluid
- Iron deficiency anemia (cancer)
- Malabsorption
- Barret’s surveillance
Therapeutics indications for upper GI endoscopy
- Treatment of bleeding lesions
- Endoscopic mucosal
resection or endoscopic
submucosal dissection
for dysplasia or early
cancer - Variceal banding and sclerotherapy
- Argon plasma cogulation for suspected vascular abnormality
- Place stent across stenosis
- Endoscopic myotomy
for achalasia or
gastroparesis - Stricture dialtion
- Polypectomy
- Endoscopic bariatric
procedures - Remove foreign body
What can be visualized with sigmoidoscopy? Distance covered?
Examines the colon to the splenic flexure (typically to 60 cm from the anal verge)
Procedure for colonoscopy
- Sedation (see earlier in topic) and analgesia are given before
- Performed by passing a flexible colonoscope through
the anal canal into the rectum and colon
Complications of colonoscopy
Abdominal discomfort; incomplete examination; haemorrhage after biopsy or polypectomy; perforation (<0.1%).
Preperation for colonoscopy
Stop iron 1wk prior (iron coats the colon, making it difficult to see the lining); discuss with local endoscopy unit bowel preparation and diet required
Diagnostic indications for colonoscopy
- Lower GI bleeding
- Obstruction
- Iron deficiency anemia (cancer)
- Persistent diarrhea
- Assessment or suspicion of IBD
- Biopsy radiologic abnormality
- Cancer surveillance and screening: age, family history prior polyp/
cancer, colitis
Therapeutic indications for colonoscopy
- Polypectomy
- Remove foreign body
- Place sent across stenosis
What are indication for sigmoidoscopy?
- Primarily used for evaluation of diarrhea and rectal outlet
bleeding - It can be used therapeutically, eg for decompression of sigmoid volvulus
