ASGE Annual GI Advanced Practice Provider Course (Virtual) (Day One)

Pdf Summary

This document is a teaching overview of <strong>upper GI endoscopy</strong> (upper endoscopy) by John A. Martin, MD, focused on definitions, indications, procedural components, documentation, and follow-up. “Upper GI endoscopy” is defined broadly as <strong>any endoscopic evaluation of the upper GI tract (esophagus, stomach, duodenum)</strong> performed via a <strong>natural orifice</strong>—typically the <strong>mouth</strong>, but sometimes the <strong>nares</strong>. The term encompasses multiple procedures beyond standard EGD, including <strong>esophagoscopy, esophagogastroscopy/EGD, push enteroscopy, and balloon enteroscopy</strong>, and may also involve advanced/interventional techniques (e.g., ERCP/EUS-related endoscopy, endoluminal Barrett’s and GERD therapies, third-space endoscopy, stenting/anastomoses, bariatric endoscopy).

A central theme is that endoscopy is <strong>not a stand-alone test</strong>; its value and safety depend on integrating it into overall disease management and communicating clearly with the patient and care team across all phases: <strong>consultation, pre-procedure preparation, the procedure, and post-procedure care</strong>, plus thorough documentation and photodocumentation.

<strong>Diagnostic indications</strong> include GERD; <strong>esophageal dysphagia/odynophagia</strong>; upper abdominal discomfort/bloating/dyspepsia; evaluation for celiac disease; abnormal imaging; GI bleeding or iron deficiency anemia; unexplained diarrhea; and selected screening/surveillance (e.g., <strong>varices</strong>, <strong>Barrett’s esophagus</strong>, polyposis/cancer syndromes, gastric intestinal metaplasia, post-resection surveillance). <strong>Therapeutic indications</strong> include hemostasis (non-variceal/variceal), dilation of strictures, ablation/resection of neoplasia/Barrett’s, endoluminal therapies for motility disorders, stenting, feeding tube placement, and bariatric therapies.

Pre-procedure priorities include confirming the <strong>appropriateness/urgency</strong>, assessing contraindications and anatomy/medical issues, obtaining <strong>informed consent</strong> (as a process), choosing sedation level, ensuring NPO status, and managing medications (especially <strong>antithrombotics</strong> and glycemic control). Risks are generally low in diagnostic EGD but include cardiopulmonary events, bleeding, perforation, infection, and rare mortality; therapeutic procedures carry higher risk. <strong>Antibiotic prophylaxis</strong> is usually unnecessary, but is recommended for <strong>cirrhotics with active GI bleeding</strong> and for <strong>PEG placement</strong>. Post-procedure care emphasizes recovery assessment, review of findings, discharge instructions, medication/antithrombotic restart guidance, and vigilance for delayed adverse events.

Asset Subtitle

John A. Martin, MD, FASGE

Keywords

upper GI endoscopy

esophagogastroduodenoscopy (EGD)

esophagus stomach duodenum evaluation

diagnostic indications

therapeutic endoscopy

Barrett’s esophagus surveillance

gastrointestinal bleeding hemostasis

informed consent and pre-procedure preparation

sedation and NPO management

antithrombotic medication management