Diagnostic and Therapeutic Procedures, Including Endoscopy
Scope
Upper and lower endoscopy, liver biopsy, manometry, pH-impedance testing, and therapeutic interventions such as polypectomy and variceal banding.
Concepts
- Endoscopy indications: GI bleeding, dysphagia, chronic diarrhea, suspected IBD, and foreign body removal. Contraindications include hemodynamic instability and perforation.
- Preparation: fasting, bowel prep for colonoscopy, and anesthesia assessment.
- Complications: bleeding, perforation, sedation reactions, and post-polypectomy syndrome.
- pH-impedance: detects acid and non-acid reflux; useful when GERD diagnosis is unclear.
- Liver biopsy: assess for metabolic disease, autoimmune hepatitis, and staging.
Traps
Candidates forget to stabilize a bleeding patient before endoscopy. Another trap: assuming endoscopy is always diagnostic in EoE or celiac-biopsies are required. Beware sedation risks in children with obesity or sleep apnea.
Worked example
A child with hematemesis and hemodynamic instability: resuscitate, transfuse, and start acid suppression before urgent endoscopy. Do not scope an unstable patient without stabilization.
Rule of thumb
Resuscitate before you endoscope. Biopsy is required for EoE and celiac diagnosis.