Upper GI endoscopy

Upper GI endoscopy

Anesthesia type	MAC vs. GA
Airway	Natural airway w/ bite block
Lines and access	1 PIV
Monitors	Standard ASA
Primary anesthetic considerations
Preoperative	GERD, unstable airway from upper GI bleed
Intraoperative	Aspiration risk
Postoperative
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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
Airway	Especially important to assess risk of patient obstructing upon induction when GA with natural airway or MAC is the anesthetic plan.
Neurologic
Cardiovascular
Pulmonary	Review risk factors for OSA i.e STOP BANG
Gastrointestinal
Hematologic	Patients may be acutely anemic from upper gi bleed, assess appropriateness of transfusing PRBC prior to procedure
Renal
Endocrine
Other

Labs and studies

Preoperative Hgb for patients with severe bleeding.

Operating room setup

• Nasal cannula/POM mask
• Bite Block
• Propofol drip
• Prepare to manage airway if severe hypoxemia develop, with ability to provide positive pressure ventilation with 100% oxygen.
• Succinylcholine for treatment of laryngospasm

Patient preparation and premedication

Consider using an antisialagogue such as glycopyrrolate for patients considered high risk for increased secretions.

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. Use nasal cannula or POM mask for oxygenation. Nasal CPAP or High flow oxygen may be appropriate for patients at high risk of obstructing and becoming hypoxemic.

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
• Intermittent boluses of propofol may be used in shorter duration cases
• A fentanyl push prior to scope insertion (25 mcg) can help minimize coughing
• The patient being able to tolerate a jaw thrust prior to scope insertion can help determine if patient is deep enough if procedure done under MAC

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.

Hypoxemia

Procedure variants

	Variant 1	Variant 2
Unique considerations
Position
Surgical time
EBL
Postoperative disposition
Pain management
Potential complications