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Elective endoscopy in patients on anticoagulants and antiplatelet agents Endoscopic procedures vary in their potential to produce significant or uncontrolled bleeding. Diagnostic oesophagogas troduodenoscopy (OGD), colonoscopy , enteroscopy , diagnostic EUS and...

Elective endoscopy in patients on anticoagulants and antiplatelet agents Endoscopic procedures vary in their potential to produce significant or uncontrolled bleeding. Diagnostic oesophagogas troduodenoscopy (OGD), colonoscopy , enteroscopy , diagnostic EUS and...

Equipment A full description of all available endoscopic equipment is beyond the scope of this chapter. However, each unit should have a su ffi cient range of endoscopes, processors and accesso - ries as dictated by the local case mix and su ffi cient endoscope...

HISTORY OF ENDOSCOPY Over the last 50 years, endoscopy has become a powerful - diagnostic and therapeutic tool. However, its development required two obvious but formidable barriers to be overcome. - First, the gastrointestinal tract is rather long and tortuo...

Indications for oesophagogastroduodenoscopy A full assessment of the role of OGD is outside the scope of this chapter. It will vary with local circumstances and the availability of alternative diagnostic techniques. OGD is usually appropriate when a patient...

Instrument decontamination Endoscopes will not withstand steam-based autoclaving and therefore require high-level disinfection between cases to prevent transmission of infection. Although accessories may be autoclaved, best practice requires the use of dispo...

INTRODUCTION The gastrointestinal tract has a myriad of functions, such as digestion, absorption and excretion, as well as the synthesis of an array of hormones, growth factors and cytokines. In addi tion, a complex enteric nervous system has evolved to cont...

Learning objectives To gain an understanding of: The role of endoscopy as a diagnostic and therapeutic • tool The basic organisation of an endoscopy unit and its • equipment Consent and safe sedation • Special situations: the key points in managing endoscopy •...

Optical diagnosis and image enhancement With the assistance of advanced imaging techniques, endosco - pists are now able to characterise colorectal polyps with high diagnostic accuracy . This begins with a white light assessment: polyps larger than 2 /uni00A0...

SAFE SEDATION If performed competently the majority of diagnostic endos - copies and colonoscopies can be performed without sedation or with pharyngeal anaesthesia alone. However, therapeutic - procedures may cause pain and patients are often anxious; thus, ...

Single-/double-balloon enteroscopy This technique allows the direct visualisation of and ther - apeutic intervention for the entire small bowel and may be attempted via either the oral or rectal route. Double-balloon enteroscopy involves the use of a thin en...

THE MODERN ENDOSCOPY UNIT Organisation A well-designed endoscopy unit sta ff ed by trained endoscopy nurses and dedicated administrative sta ff is essential to support good endoscopic practice and training. Clinical governance with regular appraisal and assessme...

Therapeutic colonoscopy The most common therapeutic procedure performed at colo - noscopy is resection of colonic polyps ( Figure 9.16 ). Retrieved specimens can be assessed for risk factors for neoplastic progres - - sion and an appropriate surveillance stra...

Therapeutic endoscopic retrograde cholangiopancreatography It is essential to ensure that patients have appropriate assess - ment prior to therapeutic ERCP , which is associated with a significant morbidity and occasional mortality . All patients require routin...

Therapeutic endoscopic retrograde cholangiopancreatography It is essential to ensure that patients have appropriate assess - ment prior to therapeutic ERCP , which is associated with a significant morbidity and occasional mortality . All patients require routin...

Therapeutic oesophagogastroduodenoscopy Appropriate patient selection and monitoring are essential to minimise complications. The most common therapeutic endo scopic procedure performed as an emergency is the control of upper gastrointestinal haemorrhage of ...

UNDERGOING ENDOSCOPY Many patients undergoing endoscopy may be taking a medica tion that interferes with normal haemostasis, such as warfarin, heparin, direct oral anticoagulants, clopidogrel or aspirin. The key points to remember when managing anticoagulants ...

UPPER GASTROINTESTINAL ENDOSCOPY OGD is the most commonly performed endoscopic procedure. Excellent visualisation of the oesophagus, gastro-oesophageal junction, stomach, duodenal bulb and second part of the duodenum can be obtained. Retroversion of the gas...