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

09_ Upper Endoscopy - Martin
Pdf Summary
Upper endoscopy, also known as upper GI endoscopy, is a procedure used to examine the upper gastrointestinal (GI) tract, including the esophagus, stomach, and duodenum. It can be performed for both diagnostic and therapeutic purposes. The procedure is typically performed through the mouth or nose using an endoscope.<br /><br />The indications for upper endoscopy include routine re-evaluation of duodenal and gastric ulcers, yearly biopsy surveillance of Barrett's esophagus, and colorectal cancer screening. The informed consent process should include a discussion about the procedure indication, procedure-related risks, obtaining the patient's written signature, and providing an opportunity for the patient to ask questions.<br /><br />Upper endoscopy is not indicated for the workup of lower abdominal pain or biliary-type upper abdominal discomfort. It is, however, indicated for the workup of esophageal dysphagia and oropharyngeal dysphagia. The term "upper GI endoscopy" is broadly encompassing and includes different procedures such as esophagoscopy, esophagogastroscopy, and single-balloon enteroscopy, among others.<br /><br />During the procedure, different types of endoscopes may be used, but video capsule endoscopes, transnasal endoscopes, and colonoscopes are not typically used for upper GI endoscopy. The procedure allows for the evaluation of the upper GI tract anatomy, including the esophagus, stomach, and duodenum.<br /><br />In terms of peri-procedure considerations, it is important to assess the appropriateness of the indication, any contraindications in the patient, the urgency of the procedure, and obtain informed consent. Sedation options should be discussed, and appropriate preparation and management of medications, including antithrombotics and antibiotics, should be ensured. Potential adverse events and post-procedure follow-up should also be considered.<br /><br />The procedure can be used for both diagnostic and therapeutic purposes. Diagnostic indications include gastroesophageal reflux disease, dysphagia, upper abdominal discomfort, gastrointestinal bleeding, and unexplained diarrhea, among others. Therapeutic indications include hemostasis for gastrointestinal bleeding, resection or ablation of neoplasms or Barrett's esophagus, and stricture dilation, among others.<br /><br />Informed consent is an important aspect of the procedure and should include a discussion of the procedure indication, risks, potential benefits, and alternatives, as well as an opportunity for the patient to ask questions. The procedure carries a low rate of adverse events, with cardiopulmonary events being the most common. Proper care during the pre-procedure, intra-procedure, and post-procedure phases is necessary to ensure the safety and efficacy of the procedure.<br /><br />Overall, upper endoscopy is a valuable tool for the management of various gastrointestinal conditions. Effective communication with patients and the care team, proper informed consent, and adherence to best practices in pre- and post-procedure care are essential for successful outcomes.
Keywords
upper endoscopy
upper GI endoscopy
esophagus
stomach
duodenum
diagnostic purposes
therapeutic purposes
informed consent
gastrointestinal conditions
pre-procedure care