Upper gastrointestinal endoscopy comprises of three basic steps – to maneuver the endoscope systematically, to inspect every part of the upper GI tract, familiarization with the normal appearance and to recognize the pathology if any.
PREPARATION FOR ENDOSCOPY
Informed consent and counseling: The patient should be clearly explained about the procedure and the likely discomfort he may experience. He should be convinced that his co-operation will make the procedure easier and quicker.
Overnight fasting: Routine endoscopy is usually performed in the morning hours after overnight fasting. Coating agents like antacids or colored medications should be clearly withheld. In case of obstructed stomach prior nasogastric intubation and lavage should be performed to clear the gastric residue.
Sedation and anesthesia: For routine UGI endoscopy we use only topical pharyngeal anesthetics like Lignocaine viscus or spray. Sedation, in the form of intravenous Midazolam is occasionally used in children.
Endotracheal intubation and monitoring: Endoscopy in a comatosed or irritable patient is fraught with the risk of aspiration, hypoxia and ‘bite’ damage to the endoscope. It is our practice to use prior endotracheal intubation and also monitor the vital parameters during the procedure.
Instrument check: It is a good practice to check the instrument like light source, suction channel, airflow and display panel for any malfunction.
Position of the patient: Diagnostic endoscopy is always performed in left lateral position.
Antibiotic prophylaxis: Antibiotic prophylaxis is not indicated for diagnostic endoscopy. Current recommendations by American Society for Gastrointestinal Endoscopy (ASGE) exclude even conditions like valvular heart disease, prosthetic valves, synthetic vascular graft and prosthetic joints from the ambit of antibiotic prophylaxis.
Fig. 1.1: View as the endoscope enters the oral cavity. Dorsum of the tongue (T) and hard palate (P)
Fig. 1.4: The laryngo-pharynx. Larynx (L) and both pyriform fossae (RPF, LPF). The arrow points to the esophageal inlet
Figs 1.12A and B: (A) Mucosal folds converging on pylorus, (B) Mucosal folds around pylorus flattened out