Endoscopic evaluation of the GI tract

Question 1

• evaluating distal colon and rectum
• 60 cm scope
• typically evaluate from rectum to descending colon
• non-sedated
• 10 minutes
• may cause cramping
• inexpensive

Answer 1

Flexible sigmoidoscopy

Question 2

• evaluate large intestine/ terminal ileum
• 160cm scope
• done with conscious sedation
• prep : PEG solution; polyethylene glycol (not absorbed- draws water into the colon)

Answer 2

Colonoscopy

Question 3

indications for a colonoscopy?

Answer 3

• colon cancer screening, post polypectomy/cancer surveillance
• unexplained Fe deficiency anemia
• suspected inflammatory bowel disease
• change in bowel habits
• therapeutics including polypectomy, FB removal, decompression, hemostasis

Question 4

• view from upper esophageal sphincter (UES) through descending duodenum
• often sedated procedure in the U.S
• wide variety of scope sizes (transnasal to double channel)

Answer 4

EGD

Question 5

Indications for EGD?

Answer 5

• dyspepsia
• reflux symptoms without response to rx
• dsyphagia/ odynophagia
• persistent nausea/ vomiting w/no etiology
• abnormal radiographic studies
• therapy: inc. hemostasis, biopsy, FB removal, dilation, feeding tube placement

Question 6

• side viewing scope passed with less visual cues
• requires fluoroscopy (radiologic imaging)
• removal of common bile duct stones
• treatment of jaundice secondary to malignancy
• can cause pancreatitis due to manipulation, contrast, high pressure in pancreatic duct

Answer 6

ERCP

Question 7

• propelled by peristalsis
• patient able to follow their usual activities
• total time is 24 hours (10-48), stomach 80 minutes (17-280) small bowel 90 minutes (45-140)
• utility is in evaluating the the small bowel

Answer 7

capsule endoscopy

Question 8

indications for enteroscopy

Answer 8

• Evaulation of GI bleeding
• small bowel biopsies
• abnormal x-ray studies
• typical findings: angiodysplaia, ulcer, small bowel tumor

Question 9

indications of endoscpic ultrasound?

Answer 9

• stage malignancies- esophagus, rectum, pancreas, stomach
• evaluation of pancreas/biliary tree (cysts, stones)
• submucosal tumor evaluation
• therapeutics- FNA biopsy, pseudocyst drainage, celiac plexus block