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gastrointestinal endoscopy

A procedure for viewing the interior of the body. For gastrointestinal endoscopy video atlas see DAVE Procedure: - propofol often used for sedation [10] Laboratory: - none routinely indicated - testing may be indicated depending upon medical history & physical examination findings - coagulation studies: - active bleeding - known or suspected bleeding disorder - medication risk (anticoagulation, prolonged antibiotics) - prolonged biliary obstruction - history of abnormal bleeding - history of liver disease - malabsorption (sprue) - malnutrition - acquired coagulopathies (leukemia) - Type & cross-match if blood transfusion considered likely - complete blood coutn (CBC): - anemia - risk factors for bleeding - high risk for adverse events with significant bleeding - advanced liver disease - hematologic disorder - procedure associated with a high risk of bleeding - chemistries - significant endocrine, renal, or hepatic dysfunction - medications that may further impair function Special laboratory: - electrocardiogram: - advanced age & comorbid illness - heart disease, arrhythmia, diabetes, hypertension, & electrolyte disturbances Radiology: - chest x-ray - advanced age, - significant smoking history - recent upper respiratory tract infection - severe or decompensated cardiopulmonary disease Complications: - excess risk (12/1000) of thromboembolism* within 30 days of procedure# if anticoagulation* is withheld [1] - complication rates were 1% for EGD & screening colonoscopy and 0.7% for diagnostic colonoscopy - infection from contaminated endoscopes - cluster of E coli infections where protocol was followed [6] - aspiration pneumonia [10] - colonic perforation [10] - serous complications associated with older age & longer duration of general anesthesia [10] * excess risk of stroke in patients anticoagulated for atrial fibrillation Management: - repeating upper gastrointestinal endoscopy or colonoscopy may detect source of obscure GI bleed [2] - direct oral anticoagulants should be stopped 24-36 hours prior to procedure in low to intermediate-risk patients # gastroscopy, colonoscopy

Related

endoscope gastrointestinal system; GI tract (GIT)

Specific

capsule endoscopy colonoscopy flexible sigmoidoscopy ileoscopy jejunoscopy proctoscopy upper gastrointestinal (GI) endoscopy; esophagogastroduodenoscopy (EGD)

General

endoscopy

References

  1. Journal Watch 23(23):183, 2003 Blacker DJ et al, Neurology PMID: 14526038
  2. Medical Knowledge Self Assessment Program (MKSAP) 15, 16, 17 American College of Physicians, Philadelphia 2009, 2012, 2015
  3. Leffler DA et al. The incidence and cost of unexpected hospital use after scheduled outpatient endoscopy. Arch Intern Med 2010 Oct 25; 170:1752. PMID: 20975024
  4. Akerman PA, Agrawal D, Chen W, Cantero D, Avila J, Pangtay J. Spiral enteroscopy: a novel method of enteroscopy by using the Endo-Ease Discovery SB overtube and a pediatric colonoscope. Gastrointest Endosc. 2009 Feb;69(2):327-32 PMID: 19100974
  5. ASGE Standards of Practice Committee, Sharaf RN, Shergill AK, Odze RD et al Endoscopic mucosal tissue sampling. Gastrointest Endosc. 2013 Aug;78(2):216-24 PMID: 23867371 also see corresponding NGC guideline
  6. Epstein L et al New Delhi Metallo-beta-Lactamase-Producing Carbapenem-Resistant Escherichia coli Associated With Exposure to Duodenoscopes. JAMA. 2014;312(14):1447-1455. PMID: 25291580 http://jama.jamanetwork.com/article.aspx?articleid=1911326 - Rutala WA and Weber DJ Gastrointestinal Endoscopes. A Need to Shift From Disinfection to Sterilization? JAMA. 2014;312(14):1405-1406. PMID: 25291575 http://jama.jamanetwork.com/article.aspx?articleid=1911309
  7. Guidelines on the role of endoscopy in patients with chronic pancreatitis. American Society for Gastrointestinal Endocopy (ASGE) http://www.asge.org/nspages/practice/patientcare/sop/index.cfm
  8. ASGE Standards of Practice Committee, Anderson MA et al Management of antithrombotic agents for endoscopic procedures. Gastrointest Endosc. 2009 Dec;70(6):1060-70. PMID: 19889407
  9. Early DS, Lightdale JR, Vargo JJ, et al. Guidelines for sedation and anesthesia in GI endoscopy. Gastrointest Endosc. 2018 Feb;87(2):327-337. PMID: 29306520 http://www.giejournal.org/article/S0016-5107(17)32111-9/fulltext
  10. Lieber SR, Heller BJ, Martin CF, Howard CW, Crockett S. Complications of anesthesia services in gastrointestinal endoscopic procedures. Clin Gastroenterol Hepatol 2019 Oct 14; PMID: 31622738 https://www.cghjournal.org/article/S1542-3565(19)31110-3/pdf