Difference between revisions of "Upper GI endoscopy"
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. | {{Infobox surgical procedure | ||
| anesthesia_type = MAC vs. GA | |||
| airway = Natural airway | |||
| lines_access = 1 PIV | |||
| monitors = Standard ASA | |||
| considerations_preoperative = GERD, unstable airway from upper GI bleed | |||
| considerations_intraoperative = Aspiration risk | |||
| considerations_postoperative = | |||
}} | |||
An upper GI endoscopy (or EGD) is a procedure where a flexible scope is inserted through the mouth to diagnose and treat problems with the upper GI tract (esophagus, stomach, duodenum). It is commonly used to further work up patients with: | |||
* upper GI bleed | |||
* severe GERD | |||
* dysphagia | |||
* intractable vomiting | |||
* non-cardiac chest/abdominal pain | |||
* unexplained weight loss | |||
== Preoperative management == | |||
=== Patient evaluation<!-- Describe the unique and important aspects of preoperative evaluation. Add or remove rows from the systems table as needed. --> === | |||
{| class="wikitable" | |||
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!System | |||
!Considerations | |||
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|Neurologic | |||
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|Cardiovascular | |||
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|Respiratory | |||
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|Gastrointestinal | |||
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|Hematologic | |||
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|Renal | |||
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|Endocrine | |||
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|Other | |||
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=== Labs and studies<!-- Describe any important labs or studies. Include reasoning to justify the study and/or interpretation of results in the context of this procedure. If none, this section may be removed. --> === | |||
Preoperative Hgb for patients with severe bleeding. | |||
=== Operating room setup<!-- Describe any unique aspects of operating room preparation. Avoid excessively granular information. Use drug classes instead of specific drugs when appropriate. If none, this section may be removed. --> === | |||
* Nasal cannula | |||
* Propofol drip | |||
=== Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. --> === | |||
=== Regional and neuraxial techniques<!-- Describe any potential regional and/or neuraxial techniques which may be used for this case. If none, this section may be removed. --> === | |||
N/A | |||
== Intraoperative management == | |||
=== Monitoring and access<!-- List and/or describe monitors and access typically needed for this case. Please describe rationale for any special monitors or access. --> === | |||
* Standard ASA monitors | |||
* 1 PIV | |||
=== Induction and airway management<!-- Describe the important considerations and general approach to the induction of anesthesia and how the airway is typically managed for this case. --> === | |||
GA w/ natural airway vs MAC sedation. The insertion of the scope itself can be quite stimulating, and many patients may not be able to tolerate this with MAC sedation. For patients with severe upper GI bleed or severe GERD who are at risk of aspiration, consider RSI with ETT to secure airway. | |||
=== Positioning<!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. --> === | |||
Generally left lateral decubitus | |||
=== Maintenance and surgical considerations<!-- Describe the important considerations and general approach to the maintenance of anesthesia, including potential complications. Be sure to include any steps to the surgical procedure that have anesthetic implications. --> === | |||
* Propofol drip | |||
=== Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. --> === | |||
== Postoperative management == | |||
=== Disposition<!-- List and/or describe the postoperative disposition and any special considerations for transport of patients for this case. --> === | |||
To PACU and generally safe discharge to home/floor within hours. | |||
=== Pain management<!-- Describe the expected level of postoperative pain and approaches to pain management for this case. --> === | |||
Minimal pain | |||
=== Potential complications<!-- List and/or describe any potential postoperative complications for this case. --> === | |||
Patients can be high aspiration risk if there is severe upper GI bleed or severe GERD. | |||
== Procedure variants<!-- This section should only be used for cases with multiple approaches (e.g. Laparoscopic vs. open appendectomy). Otherwise, remove this section. Use this table to very briefly compare and contrast various aspects between approaches. Add or remove rows as needed to maximize relevance. Consider using symbols rather than words when possible (e.g. +, –, additional symbols such as ↑ and ↓ are available using the "Ω" tool in the editor). --> == | |||
{| class="wikitable wikitable-horizontal-scroll" | |||
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!Variant 1 | |||
!Variant 2 | |||
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|Unique considerations | |||
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|Position | |||
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|Surgical time | |||
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|EBL | |||
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|Postoperative disposition | |||
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|Pain management | |||
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|Potential complications | |||
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== References == | |||
[[Category:Surgical procedures]] | |||
Revision as of 12:42, 19 November 2021
Upper GI endoscopy
| Anesthesia type |
MAC vs. GA |
|---|---|
| Airway |
Natural airway |
| Lines and access |
1 PIV |
| Monitors |
Standard ASA |
| Primary anesthetic considerations | |
| Preoperative |
GERD, unstable airway from upper GI bleed |
| Intraoperative |
Aspiration risk |
| Postoperative | |
| Article quality | |
| Editor rating | |
| User likes | 0 |
An upper GI endoscopy (or EGD) is a procedure where a flexible scope is inserted through the mouth to diagnose and treat problems with the upper GI tract (esophagus, stomach, duodenum). It is commonly used to further work up patients with:
- upper GI bleed
- severe GERD
- dysphagia
- intractable vomiting
- non-cardiac chest/abdominal pain
- unexplained weight loss
Preoperative management
Patient evaluation
| System | Considerations |
|---|---|
| Neurologic | |
| Cardiovascular | |
| Respiratory | |
| Gastrointestinal | |
| Hematologic | |
| Renal | |
| Endocrine | |
| Other |
Labs and studies
Preoperative Hgb for patients with severe bleeding.
Operating room setup
- Nasal cannula
- Propofol drip
Patient preparation and premedication
Regional and neuraxial techniques
N/A
Intraoperative management
Monitoring and access
- Standard ASA monitors
- 1 PIV
Induction and airway management
GA w/ natural airway vs MAC sedation. The insertion of the scope itself can be quite stimulating, and many patients may not be able to tolerate this with MAC sedation. For patients with severe upper GI bleed or severe GERD who are at risk of aspiration, consider RSI with ETT to secure airway.
Positioning
Generally left lateral decubitus
Maintenance and surgical considerations
- Propofol drip
Emergence
Postoperative management
Disposition
To PACU and generally safe discharge to home/floor within hours.
Pain management
Minimal pain
Potential complications
Patients can be high aspiration risk if there is severe upper GI bleed or severe GERD.
Procedure variants
| Variant 1 | Variant 2 | |
|---|---|---|
| Unique considerations | ||
| Position | ||
| Surgical time | ||
| EBL | ||
| Postoperative disposition | ||
| Pain management | ||
| Potential complications |
References
Top contributors: Tony Wang, Adam Harari, Charles Campana and Chris Rishel