Endoscopy and Procedural Care
Core concepts
Know indications, complications, and periprocedural management. Upper endoscopy evaluates dyspepsia with alarm features, bleeding, and surveillance. Colonoscopy requires adequate bowel preparation; poor prep means repeat sooner. Sedation risks include aspiration and cardiopulmonary events. Anticoagulation management: most procedures allow continuing aspirin; hold clopidogrel and anticoagulants per risk, balancing bleeding versus thrombosis. Prophylactic antibiotics are rarely indicated for GI endoscopy; they are reserved for specific high-risk scenarios such as ERCP with anticipated incomplete drainage in selected patients.
Know complications: post-ERCP pancreatitis, bleeding after polypectomy, perforation, and sedation-related events. Endoscopic retrograde cholangiopancreatography is therapeutic, not diagnostic, in most cases; MRCP or EUS often precedes it. Percutaneous endoscopic gastrostomy placement requires confirming indication and assessing aspiration risk.
Traps
Questions test inappropriate antibiotic prophylaxis. Do not stop dual antiplatelet therapy without cardiology input. Recognize that perforation may present with pain and free air, not always obvious. Do not forget consent and documentation.
Rule of thumb
For most routine endoscopy, aspirin can be continued; coordinate holding of P2Y12 inhibitors and anticoagulants with the prescribing specialist based on thrombotic risk.