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Gastrointestinal Endoscopy

Diagnostic upper GI endoscopy is indicated when a patient has abnormal findings on GI x-ray series, dysphagia, odynophagia, epigastric pain that does not respond to medical therapy, persistent heartburn, or upper GI bleeding; it is also indicated for surveillance of groups at high risk for malignancy and for biopsy of GI tissue or fluid. The patient should be hemodynamic stable.

TECHNIQUE

With the patient in the left lateral decubitus position, a topical anesthetic is applied to the posterior pharynx and an intravenous sedative administered. The forward-viewing panendoscopeľa small-caliber instrument that is long enough to permit examination of the foregut from the mouth to the third portion.

The endoscope may be introduced either blindly, via finger-guided palpation of the pharynx, or under direct vision. The latter approach is preferable. In this approach, the instrument is advanced slowly.

As the endoscope is advanced, insufflation is continued, and the curve of the lumen is followed to the left as the esophagus traverses the diaphragm to enter the stomach. There is a pinched area.

As the instrument is advanced toward the gastric antrum, its tip should be slightly elevated because the stomach has a J shape and the prepyloric region curves upward. The pylorus is normally round.


COMPLICATIONS

Esophagogastroduodenoscopy is an extremely safe procedure. Perhaps the most common problems associated with the technique.

Therapeutic Esophagogastroduodenoscopy

CONTROL OF VARICEAL HEMORRHAGE


In patients with massive upper GI hemorrhage, the first priorities are to establish
a secure airway and to ensure hemodynamic stability. These priorities must be

CONTROL OF NONVARICEAL HEMORRHAGE

Bleeding from peptic ulcer disease, gastritis, or vascular malformations is a
common indication for esophagogastroduodenoscopy. Once the patient has been
adequately resuscitated, endoscopy should be performed and the entire esophagus,
stomach, and duodenum should be examined thoroughly. Before the procedure is begun, the stomach should be vigorously irrigated through a large-bore tube so that


DILATION OF ESOPHAGEAL STRICTURES

When patients complain of dysphagia or odynophagia, prompt endoscopic
investigation is warranted. Strictures may be secondary to reflux disease, secondary
to caustic burns, or of

STENTING OF ESOPHAGEAL TUMORS


Under optimal circumstances, esophageal tumors should be treated by means of
extirpative surgery. When surgical cure or palliation seems to offer little, placement


PERCUTANEOUS ENDOSCOPIC GASTROSTOMY

Since 1980, endoscopically guided placement of a tube gastrostomy has been
widely employed to provide access to the GI tract for feeding or decompression.
Indications for percutaneous endoscopic gastrostomy (PEG) include various disease

Diagnostic Endoscopic Retrograde Cholangiopancreatography

Endoscopic retrograde cholangiopancreatography (ERCP) is an advanced
procedure that is technically more challenging than standard upper GI endoscopy;
however, it can be mastered by most endoscopists who are willing to dedicate
sufficient time to learning the method. ERCP yields a radiologic image of the

Therapeutic Endoscopic Retrograde Cholangiopancreatography

Therapeutic interventions that may be accomplished at the time of ERCP include
sphincterotomy for ductal access or ampullary stenosis, removal of CBD stones,


Diagnostic Colonoscopy

Colonoscopy has become one of the most frequently performed endoscopic
examinations. It has revolutionized the diagnosis and treatment of colonic disease
and offers the promise of reducing the occurrence of colon cancer. Indications for
colonoscopy


Therapeutic Colonoscopy

By far the most common use of therapeutic colonoscopy is for the excision of
polyps. Other applications include control of bleeding, dilation of strictures, and