Preparation for Endoscopy

Dr. Ngiu CS Gastroenterology Unit PPUKM

Preparation for Endoscopy

History and examination Consent Routine laboratory investigation Antibiotic prophylaxis Sedation Anticoagulation Anti-thrombotic therapy

History and Examination

Drugs: Use of aspirin and other NSAIDs, anticoagulation, alcohol, herbal therapy and allergies History of ulcers, weight loss, dysphagia, heartburn, an abdominal aortic aneurysm (AAA) Previous endoscopy and complication Previous UGIB Diabetes mellitus Cardiopulmonary disease and pacemaker/defibrillator

Indication

Relative Contraindication

Consent
The patient s pertinent medical diagnosis and test results. Proposed procedure. Reason the procedure is being suggested. Benefits of the procedure. Risks and complications of the procedure Alternatives to the proposed procedure. Prognosis if the treatment or test is declined.

Complication of Gastroscopy
Over all 0.1% Gastrointest Endosc 1976;23:16 9 Perforation 0.02% to 0.2% Am J Gastroenterol 1999;94:1539 45 Hemorrhage <0.15% Infection/aspiration Mallory-Weiss tear Cardiac arrthymia

Laboratory tests
Routine testings are not recommended before endoscopy. based on the perceived level of risk as determined by the medical history and P.E
Coagulation CXR ECG FBC Others

Sedation & Anesthesia

 Unsedated
Use of pharyngeal anesthesia Cx: aspiration, methemoglobinaemia, anaphylatoid reaction

Sedation

Methods for patient monitoring

Hemodynamic monitoring pressure Electrocardiography Pulse oximetry
Relatively insensitive for detecting early hypoventilation

Heart rate and blood

Significant cardiovascular disease or dysrhythmias; Not required for low-risk patients

Capnography
More sensitive than direct visual observation or pulse oximetry for detecting hypoventilation

Just before to endoscopy

NBM for about 6 hours (usually overnight) Assessment of vital signs and cardiopulmonary status Details concerning risks and risk reduction Intravenous access Removal of spectacles and dentures

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