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Upper GI endoscopy indication

and preparation

1388 :‫سال‬
UPPER GI ENDOSCOPY
INDICATION AND PREPARATION
• ESOPHAGOGASTRODUODENOSCOPY
OR GASTROSCOPY
• DEFINATION:
• DIRECT VISUAL EXAMINATION OF THE UPPER
GASTROINTESTINAL TRACT BY MEANSOF A FLEXIBLE
FIBEROTIC ENDOSCOPE.

• LOOK FOR:
• ULCER , EROSTION , POLYP , STRICTURES ,
MALIGNANCY ,VARICES , BLEEDING SITE.

• EQUIPMENT
ENDOSCOPY TYPES
1. Rigid GI endoscopy
2. Semiflexible endoscopy
3. Fiberoptics endoscopy
4. ERCP ( endoscopic retrograde cholangeo
pancreatography
5. Digital endoscopy
6. Endoscopic ultrasound
7. Capsule endoscopy
Capsule endoscopy

1. Capsule
2. Receiving and storing system
3. Workstation for image
integration( into video) and analysis
INDICATION FOR UER GI
ENDOSCOPY
High yield indication
1. Acute upper GI bleeding
2. Disphagia
3. Dispepsia (refractory anti refux)
4. Odinophagia
5. Surveillance endoscopy ( barrett`s
esophagitis , lye-induced strictures , plummer –
vinson syndrome )
6. Abnormalities seen on upper GI serios
7. Suspected gastric outlet obstruction
INDICATION FOR UPPER GI
ENDOSCOPY
• Lower yield indication( procedure not
always appropriate)
1. Atypical chest pain
2. Abdominal pain of unknown etiology
3. Routine uncomplicated case of
gastroesophageal reflux
4. Uncompplicated case of duodenal
ulcers
Therapeutic indication for
EGD
1. Sclerotherapy of bleeding esophageal varices
2. Management of upper GI bleeding
3. Laser ablation of esophageal cancer
4. Endoscopic placement of esophageal stints
5. Placement of permanent feeding tubes
under endoscopic guidance
6. Dilatation of esophageal st‫ق‬
st‫ق‬uictures
7. Polypectomy
8. Dissolution of bezoars
Contraindication

1. Acute myocardial infarction


2. Hypoxiemia respiratory distress
3. Hypotension and shock regardless of
etiology
4. Massive upper GI bleeding with
hypotension
5. Uncontrolled hypertension
6. Patient refusal
Relative contraindications(high
risk situations) include:
1. Noncorrectable coagulopathy
2. Recent myocardial infarction
3. Severe coronary artery disease
4. Recent upper GI tract surgery where
anastomotic sites may still be fresh
5. Active peritonitis
6. Subluxation or instability of the cervical spine
7. Anterior cervical spine osteophytes
8. PERFORATED VISCUS
9. Zenker`s diverticulum
PATIENT PREPARATION
1. Understanding of the patient particular clinical problem
2. An awareness of the patient`s clinical history
3. A knowledge of the patient`s recent and post
medication history
4. What procedure specific preparation is required
5. What patient specific preparation is required
6. Informed consent
7. Post procedure observation and discharge planning
Pre procedural preparation
• Preparation for endoscopy
• Preparation for ERCP
• Preparation for endoscopic ultrasound
• Preparation for capsule endoscopy
• Preparation for endoscopic procedure in
patient with diabetes.
• Preparation for endoscopic in case of ingestion
of a foreign bodies or for food bolus
obstruction
• Preparation for endoscopic in patient with
upper GI bleeding
• Sedation
Procedural monitoring

• Level of consciousness
• Pulmonary ventilation
• Pulse oximetry
• Homodynamic measurement
• Supplemental oxygen
Post procedural monitoring
1. Not to drive
2. Not to operate heavy dangerous machinary
3. Not to sign any legally documents
4. To arrange escort home with an able
companion
5. Written instruction regarding the sign and
symptoms of any advise outcome of the
procedure and contact numbers for 24
hours advice.
complications
1. Perforation of esophagus or stomach (0.1%)
2. Bleeding ( 0.03%)
3. Cardiopulmonary complications
significant cardiac arrhythmias, ischemic change,
pulmonary aspiration (0.08%)
4. Toxicity of premedication (local phlebitis, transient
nausea , respiratory depression.)
5. Infections ( bacteremia , infective endocarditis)
Drugs for sedation
1. Rapid onset of action
2. Practical means of delivery
3. Short half life with rapid recovery
sedative
4. Safe with predictable response
(pharmacodynamic)
5. Effective producing action, pain
free, cooperation patient.
Drugs for sedation
• Benzodiazepines
1. Midazolam
2. diazepam
• Opiates
1. Meperidine
2. Fentanyl
• Propofol in deep sedation
• Pharyngeal anasthesia
Antibiotics prophylaxis
1. Synthetic vascular grafts
2. Patient with prosthetic join
3. Endoscopic percutaneus gastrostomy
4. Valvular heart disease
5. Ascitis cirrhosis immunocompramised
patients
Usual antibiotics

• Ampicillin gentamycin amoxicillin


voncomycin
Esophageal varice
Esophageal white pill
obstruction
Gastric ulcer with bleeding
ERCP STONE IN DUODENUM
Gastric erosion
Esophageal varices
ERCP intrahepatic biliary duct
dilatation
Normal endoscopy
Ultrasound endoscopy