ABPS GI Endoscopy key terms

A six-category system (ASA I–VI) that grades a patient's systemic disease burden before sedation or anesthesia. Endoscopists use it to estimate procedural risk, choose the sedation plan, and decide whether anesthesia support is needed.

The documented process of explaining a procedure's purpose, alternatives, material risks, and expected benefits in language the patient understands, then confirming voluntary agreement. It must precede sedation and be recorded in the chart, including use of an interpreter when needed.

Dividing the cleansing solution so one portion is taken the evening before colonoscopy and the remainder roughly four to six hours before the procedure. This improves mucosal cleanliness, particularly in the right colon, and is preferred over day-before-only dosing.

A validated 0–3 scoring system applied to the right, transverse, and left colon after washing residual stool; the three segment scores are summed (0–9). Higher totals indicate cleaner mucosa, and a score of at least 2 per segment is generally considered adequate.

The planned interruption, continuation, or bridging of antiplatelet and anticoagulant drugs around endoscopy, based on bleeding risk of the procedure and thrombotic risk of the patient. Guidance from cardiology or hematology is often needed for high-risk cases.

A drug-induced depression of consciousness during which patients respond purposefully to verbal commands, alone or with light tactile stimulation. Airway, spontaneous ventilation, and cardiovascular function are maintained, so no advanced airway intervention is required.

Continuous measurement and waveform display of exhaled carbon dioxide. During endoscopy it detects hypoventilation and apnea earlier than pulse oximetry alone, making it valuable for deep sedation and for patients with respiratory comorbidity.

A short-acting benzodiazepine antagonist that reverses sedation from midazolam and similar agents. Because its duration is shorter than many benzodiazepines, patients require extended monitoring for re-sedation, and it should not be used routinely as a substitute for careful dosing.

The squamocolumnar junction in the distal esophagus, where pale stratified squamous epithelium meets salmon-colored columnar mucosa. Its position relative to the gastroesophageal junction is central to diagnosing and grading Barrett's esophagus.

A four-grade endoscopic scale (A–D) describing esophagitis severity by the length of mucosal breaks at the gastroesophageal junction. Grade A has breaks under 5 mm; grade D has breaks extending around at least 75% of the circumference.

A systematic biopsy strategy for Barrett's esophagus using four-quadrant jumbo biopsies every 1–2 cm along the Barrett's segment, plus targeted sampling of visible lesions. It improves detection of dysplasia and cancer compared with random or sparse sampling.

Passage of the colonoscope tip to the cecum, confirmed by landmarks such as the appendiceal orifice and ileocecal valve. It is the principal technical benchmark of colonoscopy quality and permits examination of the entire colonic mucosa.

The proportion of screening colonoscopies in which at least one adenoma or sessile serrated lesion is removed. It is a validated quality measure, with benchmarks around 25% overall, and correlates inversely with interval colorectal cancer.

A flat or sessile serrated polyp, typically right-sided, with crypt dilation and branching at the base. It is an important colorectal cancer precursor through the serrated pathway and can be difficult to see, so careful mucosal inspection and adequate preparation matter.

The time spent inspecting the colonic mucosa while withdrawing the colonoscope, excluding polypectomy and washing. A mean of at least six minutes is associated with higher adenoma detection and is used as a quality indicator.

Use of carbon dioxide instead of room air to distend the lumen during endoscopy. It is absorbed rapidly and exhaled, reducing post-procedural bloating and discomfort and lowering the risk of air embolism in advanced procedures.

A six-category endoscopic classification of peptic ulcer bleeding (Ia spurting through III clean base) used to predict rebleeding risk and guide hemostatic therapy. High-risk stigmata such as active bleeding or a nonbleeding visible vessel warrant endoscopic treatment.

Removal of a polyp by snaring it and transecting without electrocautery. It is preferred for small and diminutive lesions because it is fast and lowers the risk of delayed bleeding and post-polypectomy syndrome compared with hot snaring.

Injection-assisted removal of superficial mucosal lesions, usually after lifting with submucosal fluid, using a snare. It is suited to large lateral spreading lesions and early neoplasia without deep submucosal invasion, and carries a low but real perforation risk.

An en bloc resection technique using electrosurgical knives to dissect the submucosal plane beneath a lesion. It provides precise histologic margins for early cancers and large lesions but demands advanced training and carries higher perforation risk than mucosal resection.

A morphology scheme for superficial gastrointestinal neoplasms describing whether lesions are polypoid, nonpolypoid, or ulcerated, with subtypes for depressed and elevated areas. It helps predict invasion depth and guides the choice between resection and surgery.

Endoscopic incision of the major duodenal papilla and biliary sphincter using a specialized papillotome and electrocautery. It facilitates stone extraction and stent placement, and its main risks are bleeding, perforation, and post-ERCP pancreatitis.

Measures taken to reduce pancreatitis after ERCP, chiefly rectal nonsteroidal anti-inflammatory drugs such as indomethacin, aggressive intravenous hydration, and guidewire cannulation techniques. High-risk patients may also receive temporary pancreatic stent placement.

Direct endoscopic visualization of the bile ducts using a thin cholangioscope passed through or alongside a duodenoscope. It allows targeted biopsy and lithotripsy of difficult stones and helps distinguish malignant from benign biliary strictures.

Tissue sampling by passing a needle through the working channel of an echoendoscope into a lesion under real-time ultrasound guidance. It is used to diagnose pancreatic masses, lymph nodes, and subepithelial lesions, with fine-needle biopsy needles improving histologic yield.

Injection of alcohol, often with a local anesthetic, into the celiac plexus under EUS guidance to interrupt pain fibers from upper abdominal malignancy, particularly pancreatic cancer. It can improve pain control and reduce opioid requirements.

A swallowed capsule that transmits images as it passes through the small bowel, allowing direct mucosal visualization beyond the reach of standard endoscopes. It is used for obscure gastrointestinal bleeding and suspected Crohn's disease, but cannot biopsy or treat.

Push-and-pull enteroscopy using an overtube and balloon at the scope tip to pleat the small bowel and reach deep segments. It permits biopsy, hemostasis, and polypectomy in the small intestine, though it is time-consuming and carries perforation risk.

A submucosal tunnel technique that divides the lower esophageal sphincter muscle to treat achalasia. It is performed entirely through the mouth, offers durable symptom relief, and requires expertise in submucosal endoscopy and management of insufflation-related complications.

A process that destroys all vegetative bacteria, mycobacteria, fungi, and viruses except small numbers of bacterial spores, achieved for endoscopes with compatible chemical disinfectants. It is the minimum accepted reprocessing standard for gastrointestinal endoscopes between patients.

The lowest concentration of a liquid chemical disinfectant at which it remains effective, verified by test strips before each use. Falling below this threshold means the solution must be discarded and the endoscope reprocessed appropriately.

A movable lever at the duodenoscope tip that raises and deflects accessories, allowing cannulation and therapy at an angle. Because it harbors debris and moisture, it makes duodenoscopes especially challenging to clean and has been linked to multidrug-resistant outbreaks.

A routine check that pressurizes the sealed endoscope and monitors for pressure loss, detecting breaches in the outer casing before fluid enters internal channels. Failure requires removal from service and repair, since fluid invasion can damage optics and impair disinfection.

Bleeding after polyp removal, classified as immediate (during the procedure) or delayed (usually within days to two weeks). Risk rises with larger, proximally located, or pedunculated lesions and with antithrombotic use; endoscopic clips, epinephrine, or coagulation may be used.

A full-thickness bowel wall injury during endoscopy, recognized by free air, a visible defect, or extraluminal tissue. Management ranges from conservative therapy with antibiotics and bowel rest to endoscopic closure or surgery, depending on size, location, and patient stability.