• Chronic diarrhea.
• Failure to thrive.
• Abdominal pain.
• Dysphagia, odynophagia.
• Foreign body.
• Caustic ingestion.
• Histopathologic, biochemical, and microbial evaluations of pinhead-sized
biopsy specimens and sampled fluids (eg, pancreatic).
• Coagulopathy (prothrombin time > 18 sec).
• Thrombocytopenia (platelet count < 100,000/μL).
• Intestinal tract surgery within previous 1 month.
• Food intake within previous 6 hours.
• Bowel obstruction.
• Fiberoptic or video endoscopes.
• Biopsy forceps.
• Nets and baskets.
• Sclerotherapy needles.
• Banding devices.
• Heater probes.
• Electrocautery probes.
• Balloon-dilation devices.
• Guidewires and wire-guided bougie dilators.
• Biopsies are required because characteristics
of many disorders may only be detectable under the microscope.
• Retroflection with a good view of the cardia may demonstrate
source of bleeding or prolapse gastropathy.
• Obtain medical history and physical examination
for clearance from pulmonary, cardiovascular, and hematologic standpoints.
• Obtain laboratory tests, if needed.
• Primary care providers can prepare patients and families by explaining
that the procedure provides detailed diagnostic information and
rarely causes complications (1/2000 chance of significant
bleeding or perforation).
• Have parents sign a consent form.
• No oral intake for 6 hours before the procedure.
• Antibiotics for endocarditis prophylaxis in at-risk cardiac patients.
• The esophagus is divided into proximal, middle
(8–10 cm above the gastroesophageal junction), and distal
• Peptic injuries are usually located in the distal portion.
• Eosinophilic (allergic) injuries are usually located in both the
middle and distal regions.
• The stomach is composed of the cardia (underside of the gastroesophageal
junction), fundus or dome of the stomach, body or main portion with
rugal folds, and antrum the distal portion without rugae containing
the pylorus (Figure 65–1).
• Peptic gastritis and Helicobacter
pylori infection are usually located in the antrum.
• The duodenum consists of the bulb, the smooth portion immediately
after the pylorus and the second portion with circular valvulae
conniventes and the ampulla of Vater.
• Peptic injuries are found in the bulb.
• Celiac disease is found in the second portion and beyond.
Anatomy of the esophagus and stomach with esophagogastroduodenoscope
• Administer oxygen by nasal cannula.
• Start intravenous sedation or gas anesthesia via an endotracheal
• Topical anesthesia is sprayed into the oropharynx.
• Vital signs are monitored continuously....
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