C Gastroenterologic procedures: Colonoscopy, esophagogastroduodenoscopy, and endoscopic retrograde cholangiopancreatography
Endoscopy for gastrointestinal procedures is the use of a flexible fiberoptic endoscope that transmits brilliant, coherent, high-resolution, magnified, direct visual images to the operator. The operator can then examine, biopsy, dilate, or cauterize portions of the gastrointestinal tract. The endoscopist may pass accessory devices down the endoscope such as biopsy forceps, dilation devices, cytology brushes, measuring devices, needles for injection, Doppler probes, ultrasound probes, and probes to measure electrical activity and pH. Even foreign bodies may be removed with the aid of a snare passed through an endoscope.
2. Procedures
a) A colonoscopy allows total diagnostic visualization of the mucosa of the tortuous colon from the anus to the cecum.
b) An upper endoscopy, such as an esophagogastroduodenoscopy (EGD), is an accurate way for the operator to evaluate the mucosa of the esophagus, stomach, and duodenum.
c) Endoscopic retrograde cholangiopancreatography (ERCP) is used for the diagnosis of obstructive, neoplastic, or inflammatory pancreatobiliary structures.
d) Endoscopy for gastrointestinal procedures may be performed by a gastroenterologist, a general surgeon, a family practitioner, or a proctologist.
3. Anesthetic technique for colonoscopy
a) Because of the expectations of patients, endoscopically caused discomfort, and the desirability for no patient movement, moderate sedation, deep sedation, and, in some cases, general endotracheal anesthesia are used.
b) A proper preanesthetic assessment of the patient should be performed, focusing on the areas of age, ability to cooperate, level of anxiety, mental disability, allergies, fluid status, laboratory electrolyte values, cardiac history, hypertension, bleeding history, clotting status, respiratory status, obesity, drug and alcohol abuse, gastroesophageal reflux, and pregnancy.
e) Necessary medications may be given, such as cardiac medications, antihypertensives, and antibiotics.
f) Preemptive analgesia with gargled flavored viscous Xylocaine helps patient acceptance of the procedure.
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