The most common indications for diagnostic UGI scopy include.
ContraindicationsContraindications for UGI scopy include the following:
Medically unstable patients
Anticoagulation, pharyngeal diverticulum, or head and neck surgery (relative contraindications)
PATIENT PREPARATIONTopical anesthesia (eg, with lidocaine) is administered.
Eliminating the risk of sedation,
Decreasing the cost of the procedure
Less recovery time
Surveillance after polypectomy
Colorectal cancer post-resection surveillance
Inflammatory bowel diseases
Excision and ablation of lesions
Treatment of lower GI bleeding
Dilation of colonic stenosis
Foreign body removal
Isolated unexplained abdominal pain
Preoperative and intraoperative localization of colonic lesions.
Peglec solution is given in water overnight for the next morning procedure, and overnight fasting after completion of oral preparation is advised, also anaesthesia support may be necessary to ensure smooth completion of the colonoscopy procedure.
For LGI scopy, patient is placed in left lateral position ,and with slow insufflation of air, screening of the entire colon and terminal ileum is attempted., Biopsies can be obtained as per indication.
Complications are very less common in diagnostic procedures if patients health profile is good, also if endotherapy or emergency situation arises, based on the underlying disease profile of patient and the indication and patients hemodynamic condition, the complications vary.The major complications of UGI scopy /LGI scopy/Endotherapyare as follows:
For UGI/LGI bleeding , patient needs to be stabilised and after blood parameters are checked, patient can undergo intervention to stop bleed after appropriate counselling, consent, blood product transfusion as per necessary, IV infusion, and then the patient is taken up for procedure after appropriate risk stratification as per patients profile.
Variceal bleed in cirrhosis patients
Mallory Weiss tear bleed
Dieulafoy’s lesion bleed
Inflammatory bowel disease related bleed
Cancer related bleed
Coagulation disturbances and other co-existing diseases need to be ruled out.
Other causes(as per patients comorbid condition)
Ongoing bleed, rebleed despite best possible treatment measures, though less common, are possible and it may sometimes require re-endoscopy and /or re endotherapy with hemoclips, sclerotherapy etc.
Other Complications as mentioned above.
Triaging the patients, counselling the patients relatives and following appropriate treatment protocols leads to best possible outcome for that patient. If necessary, higher intervention at same centre or different centre may be suggested if facilities deem so. Despite all best measures taken by the managing team of ICU/Gastroenterologists/Physician, if the patients condition does not stabilise, they can be offered alternative treatment measures like BRTO/Surgery/as necessary.
Overall outcomes and risk to life is different for different patients and also different for the same patient in different situation, which depends on the age, comorbid conditions, co-existing other organ dysfunctions, cardio-respiratory status, neurological condition and other factors on a case-to-case basis especially in case of bleeding GI patients which are having more risk than the general population for organ dysfunction and risk to life.
Above all, trusting your doctor for the treatment is of prime importance at every step of patient care in this journey of doctor-patient relationship.
Dr. Raajeev Vijay Hingorani is a Mumbai-based Super-specialist in Gastroenterology, Hepatology and Endoscopy, currently practising at Gastronaut Clinic Kandivali and Mira Road, and aslo at Apex Superspeciality Hospital in Borivali (W), Thunga Hospital in Malad (W). Globus Gastro Malad (W).Read More...
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