Student Presentation: EGD/Colonoscopy Flashcards
When is EGD generally indicated in one statement
Results are likely to influence management of
the patient
EGD and benign disorder
Empiric treatment for a suspected benign disorder is unsuccessful
The procedure can be used as an alternative to radiographic evaluation
Therapeutic maneuver may be needed
EGD and Barrett’s
Follow-up procedure for patients with a history of Barrett’s esophagus
EGD and Screening
for esophageal cancer for patients with multiple risk factors.
CONTRAINDICATIONS GI ENDOSCOPIC PROCEDURES
Patients factors
◘ Risks outweighs benefits
◘ Inability of patient to cooperate despite adequate anesthesia
CONTRAINDICATIONS GI ENDOSCOPIC PROCEDURES
Patients factors
◘ Risks outweighs benefits
◘ Inability of patient to cooperate despite adequate anesthesia
◘Inability to get informed consent
EGD and Absolute contraindications of upper and lower endoscopy include
suspected perforation and peritonitis in a toxic patient
Known or suspected perforated viscus
Relative contraindications include BCCNFTP
Bowel obstruction (colonoscopy) Coagulopathy Cardiopulmonary instability. Neutropenia, Fulminant colitis, and toxic dilation with increased risk of perforation, torrential colonic bleeding, poor bowel preparation (colonoscopy
Contraindications with diet (Colonoscopy)
Failure to comply with dietary restriction prior to procedure (Colonoscopy)
AHA recommends waiting: Wait how long after MI
60 days
AHA recommends waiting: Wait how long after ballon angioplasty?
14 days after balloon angioplasty
AHA recommends waiting: Wait how long after bare metal stent implantation?
30 days after bare metal stent implantation
AHA recommends waiting Patients with drug eluting stents
must wait 1 year OR
AHA recommends waiting Patients with drug eluting stents : RISK OF WAIT> RISK OF ISCHEMIA
180 days if risk of delay is greater than risk of ischemia
For Antiplatelet therapy risk of bleeding:
Diagnostic (low) Therapeutic (High)
Antiplatelet therapy , high and low risk
With low risk –> no interruption in therapy is required.
For High risk patients undergoing EGD for therapeutic purposes:
Hold therapy: Clopidogrel
5 days prior
Hold therapy: Prasugrel
7 days prior
Hold therapy: Ticagrelor
3-5 days
Hold therapy summary
CPT 5735
ASA and therapy interruption before the procedure.
No routine interruption in therapy recommended for high risk procedures, however, delay restart to 5-7 days after high risk procedures
Anatomic considerations for EGD (SLZ)
♦Small mouth
♦Limited ROM in the jaw or in the neck,
♦Zencker’s diverticulum (↑risk of esophageal perforation during intubation.
Phases of Endoscopy: OO EEj GTDTT
●Oral intubation with the endoscope ●Oropharyngeal examination ●Esophageal examination ●Examination of the esophagogastric junction (EGJ, also referred to as the gastroesophageal junction) ●Gastric examination, including retroflexion ●Traversing the pylorus ●Duodenal examination ●Tissue sampling ●Therapeutic maneuvers
Other Positioning is
left lateral on the stretcher.
Head of bed
Elevated 25-30%.
Placed for comfort FOR POSITIONING
A pillow can be placed between the knees for padding and comfort, and ensure the arms and hands are padded from the stretcher rails.
EGD Hemodynamics : CV
Cardiac concerns – vagal nerve stimulation d/t distention of the colon causing hypotension, brady dysrhythmias, and ECG changes.
EGD Hemodynamics : Respiratory concerns –
location of the endoscope to the airway, aspiration risk d/t unprotected airway and gag reflex. Jaw thrust may be necessary to maintain the airway.
Monitor for this closely during the EGD
Over-sedation may occur, monitor closely.
Risk of vagal stimulation caused by the
insufflation of the colon and/or the looping of the colonoscope that may lead to bradycardia, other EKG changes, and hypotension
Because of possible effects of insufflation, have
Have vagolytic agents such as glycopyrrolate and atropine readily available
Risk of desaturation and hypoxemia due to ____? know _______ . may be needed to maintain a patent airway? have available? Be prepared to _________.
unprotected airway • Know patient’s respiratory status • Jaw thrust may be needed to maintain a patent airway • Have alternative oxygen delivery equipment available ( e.g.: non-rebreather mask, AMBU, etc.) • Be prepared to intubate!
Risk of hypotension due to
bowel prep solution and NPO status
IV and colonoscopy
running IV and appropriate fluids • Have vasopressors readily available
Air or CO2 may be used to CO
distend the colon.
Air is associated with more
abdominal bloating and discomfort.
CO2 has properties of
high diffusibility, rapid absorption, and rapid excretion.
Studies show that patients who have their bowel insufflated with CO2 experience
Less pain and discomfort during the postoperative period.
Progression of the endoscope
Cardia Fundus Body Greater curvature' Antrum Pylorus
