Practical Gastrointestinal Endoscopy

Practical Gastrointestinal Endoscopy: The Fundamentals, Fifth Edition
Peter B. Cotton, Christopher B. Williams
Copyright © 2003 by Blackwell Publishing Ltd
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Patient Care
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Skilled endoscopists can now reach every part of the digestive
tract, and its appendages such as the biliary tree and pancreas. It
is possible to take specimens from all of these areas, and to treat
many of their afflictions. Many patients have benefited greatly
from endoscopy. Unfortunately, in some cases it may be unhelpful,
and can even result in severe complications. There are also
some hazards for the staff. The goal must be to maximize the
benefits and minimize the risks. We need to be experts, working
for good indications on patients who are fully prepared and protected,
with skilled assistants, and using optimum equipment.
The basic principles are similar for all areas of gastrointestinal
(GI) endoscopy, recognizing that there are specific circumstances
where the risks are greater, including therapeutic and
emergency procedures.
Endoscopy is normally part of a comprehensive evaluation by
agastroenterologist or other digestive specialist. It is mostly used
electively in the practice environment, or hospital outpatient
clinic, but sometimes may be needed in any part of a healthcare
facility (e.g. Emergency Room, Intensive Care Unit, Operating
Room). Sometimes, endoscopists offer an ‘open access’ service,
where the initial clinical assessment and continuing care are
performed by another physician.
In all of these situations it is the responsibility of endoscopists
to ensure that the potential benefits exceed the potential risks,
and personally to perform the necessary evaluations to make
appropriate recommendations for their patients.
The following sections refer primarily to upper endoscopy. Issues
specific to colonoscopy are covered in Chapters 6 and 7.
INDICATIONS FOR UPPER ENDOSCOPY
Upper endoscopy is now the primary tool for evaluating the
esophagus, stomach and duodenum. It may be used for many
reasons.
Broadly speaking, the goal may be:
1–To – make a diagnosis in the presence of suggestive symptoms
(e.g. dyspepsia, heartburn, dysphagia, anorexia, weight loss,
hematemesis, anemia).
2–To – clarify the status of a known disease (e.g. varices, Barrett’s
esophagus).
3–To – take target specimens (e.g. duodenal biopsy for malabsorption).