ASGE Annual GI Advanced Practice Provider Course - Day Two

15_Upper Endoscopy-Kaul
Pdf Summary
The ASGE Annual Advanced Practice Provider (APP) Course focused on the basics of upper endoscopy (EGD). Some key points from the session include:<br /><br />- EGD is a commonly performed procedure in the US, with 6.1 million procedures annually and an estimated cost of $12.3 billion.<br />- The session emphasized the importance of appropriate patient selection and timing of the procedure.<br />- EGD involves the examination of the esophagus, stomach, and duodenum using a flexible endoscope.<br />- Patient preparation, including medication management and sedation requirements, should be carefully considered.<br />- Informed consent is crucial and should include information on the nature of the procedure, reason for the procedure, risks and benefits, and alternatives.<br />- Special considerations for pediatric patients include obtaining assent from adolescents and ensuring their cooperation during the procedure.<br />- EGD can serve as a portal for various procedures, including endoscopic ultrasound, dilation of strictures, and stent placement.<br />- Common indications for diagnostic EGD include dysphagia, GI bleeding, and GERD refractory to medical therapy.<br />- Therapeutic EGD can be used for endoscopic hemostasis, ablation therapy, and stent placement, among other interventions.<br />- Adverse events associated with EGD include aspiration, bleeding, infection, perforation, and cardiopulmonary events.<br />- Quality indicators for EGD were discussed, as well as antibiotic prophylaxis for certain procedures.<br />- Post-procedure discharge instructions should include any significant findings, follow-up instructions, and when to resume anticoagulation.<br />- EGD should only be performed for appropriate indications in appropriate patients, and detailed informed consent is necessary.<br />- Antibiotic prophylaxis is suggested for certain procedures, such as EUS-FNA of cystic lesions and PEG tube placements.<br />- Quality metrics for EGD should be followed in the pre-, intra-, and post-procedure phases.<br /><br />In the polling questions, antibiotic prophylaxis in upper endoscopy is indicated for PEG tube placement, endoscopy with duodenal biopsies for celiac disease, and patients with variceal bleeding undergoing band ligation, but not for EUS-FNA of pancreatic cysts. Cardiorespiratory events are typically associated with EGD, while pancreatitis is not.
Keywords
upper endoscopy
EGD
patient selection
esophagus
stomach
duodenum
informed consent
therapeutic EGD
adverse events
antibiotic prophylaxis