Student Presentation: EGD/Colonoscopy

Question 1

When is EGD generally indicated in one statement

Answer 1

Results are likely to influence management of

the patient

Question 2

EGD and benign disorder

Answer 2

Empiric treatment for a suspected benign disorder is unsuccessful
The procedure can be used as an alternative to radiographic evaluation
Therapeutic maneuver may be needed

Question 3

EGD and Barrett’s

Answer 3

Follow-up procedure for patients with a history of Barrett’s esophagus

Question 4

EGD and Screening

Answer 4

for esophageal cancer for patients with multiple risk factors.

Question 5

CONTRAINDICATIONS GI ENDOSCOPIC PROCEDURES

Patients factors

Answer 5

◘ Risks outweighs benefits

◘ Inability of patient to cooperate despite adequate anesthesia

Question 6

CONTRAINDICATIONS GI ENDOSCOPIC PROCEDURES

Patients factors

Answer 6

◘ Risks outweighs benefits
◘ Inability of patient to cooperate despite adequate anesthesia
◘Inability to get informed consent

Question 7

EGD and Absolute contraindications of upper and lower endoscopy include

Answer 7

suspected perforation and peritonitis in a toxic patient

Known or suspected perforated viscus

Question 8

Relative contraindications include BCCNFTP

Answer 8

Bowel obstruction (colonoscopy)
Coagulopathy
Cardiopulmonary instability.
Neutropenia,
Fulminant colitis,  and 
toxic dilation with increased risk of perforation, 
torrential colonic bleeding, 
poor bowel preparation (colonoscopy

Question 9

Contraindications with diet (Colonoscopy)

Answer 9

Failure to comply with dietary restriction prior to procedure (Colonoscopy)

Question 10

AHA recommends waiting: Wait how long after MI

Answer 10

60 days

Question 11

AHA recommends waiting: Wait how long after ballon angioplasty?

Answer 11

14 days after balloon angioplasty

Question 12

AHA recommends waiting: Wait how long after bare metal stent implantation?

Answer 12

30 days after bare metal stent implantation

Question 13

AHA recommends waiting Patients with drug eluting stents

Answer 13

must wait 1 year OR

Question 14

AHA recommends waiting Patients with drug eluting stents : RISK OF WAIT> RISK OF ISCHEMIA

Answer 14

180 days if risk of delay is greater than risk of ischemia

Question 15

For Antiplatelet therapy risk of bleeding:

Answer 15

Diagnostic (low) Therapeutic (High)

Question 16

Antiplatelet therapy , high and low risk

Answer 16

With low risk –> no interruption in therapy is required.

For High risk patients undergoing EGD for therapeutic purposes:

Question 17

Hold therapy: Clopidogrel

Answer 17

5 days prior

Question 18

Hold therapy: Prasugrel

Answer 18

7 days prior

Question 19

Hold therapy: Ticagrelor

Answer 19

3-5 days

Question 20

Hold therapy summary

Answer 20

CPT 5735

Question 21

ASA and therapy interruption before the procedure.

Answer 21

No routine interruption in therapy recommended for high risk procedures, however, delay restart to 5-7 days after high risk procedures

Question 22

Anatomic considerations for EGD (SLZ)

Answer 22

♦Small mouth
♦Limited ROM in the jaw or in the neck,
♦Zencker’s diverticulum (↑risk of esophageal perforation during intubation.

Question 23

Phases of Endoscopy: OO EEj GTDTT

Answer 23

●Oral intubation with the endoscope 
●Oropharyngeal examination 
●Esophageal examination
 ●Examination of the esophagogastric junction (EGJ, also referred to as the gastroesophageal junction) 
●Gastric examination, including retroflexion 
●Traversing the pylorus
 ●Duodenal examination 
●Tissue sampling 
●Therapeutic maneuvers

Question 24

Other Positioning is

Answer 24

left lateral on the stretcher.

Question 25

Head of bed

Answer 25

Elevated 25-30%.

Question 26

Placed for comfort FOR POSITIONING

Answer 26

A pillow can be placed between the knees for padding and comfort, and ensure the arms and hands are padded from the stretcher rails.

Question 27

EGD Hemodynamics : CV

Answer 27

Cardiac concerns – vagal nerve stimulation d/t distention of the colon causing hypotension, brady dysrhythmias, and ECG changes.

Question 28

EGD Hemodynamics : Respiratory concerns –

Answer 28

location of the endoscope to the airway, aspiration risk d/t unprotected airway and gag reflex. Jaw thrust may be necessary to maintain the airway.

Question 29

Monitor for this closely during the EGD

Answer 29

Over-sedation may occur, monitor closely.

Question 30

Risk of vagal stimulation caused by the

Answer 30

insufflation of the colon and/or the looping of the colonoscope that may lead to bradycardia, other EKG changes, and hypotension

Question 31

Because of possible effects of insufflation, have

Answer 31

Have vagolytic agents such as glycopyrrolate and atropine readily available

Question 32

Risk of desaturation and hypoxemia due to ____? know _______ . may be needed to maintain a patent airway? have available? Be prepared to _________.

Answer 32

unprotected airway • Know patient’s respiratory status • Jaw thrust may be needed to maintain a patent airway • Have alternative oxygen delivery equipment available ( e.g.: non-rebreather mask, AMBU, etc.) • Be prepared to intubate!

Question 33

Risk of hypotension due to

Answer 33

bowel prep solution and NPO status

Question 34

IV and colonoscopy

Answer 34

running IV and appropriate fluids • Have vasopressors readily available

Question 35

Air or CO2 may be used to CO

Answer 35

distend the colon.

Question 36

Air is associated with more

Answer 36

abdominal bloating and discomfort.

Question 37

CO2 has properties of

Answer 37

high diffusibility, rapid absorption, and rapid excretion.

Question 38

Studies show that patients who have their bowel insufflated with CO2 experience

Answer 38

Less pain and discomfort during the postoperative period.

Question 39

Progression of the endoscope

Answer 39

Cardia 
Fundus
Body
Greater curvature'
Antrum
Pylorus