Chapter 65. Esophagogastroduodenoscopy

• • Vomiting.

  • Hematemesis.

  • Melena.

  • 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).

Absolute

• • Cardiorespiratory collapse.

  • Unstable airway.

  • Intestinal perforation.

  • Peritonitis.

  • Cervical spine trauma.

Relative

• • 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.

  • Snares.

  • Nets and baskets.

  • Sclerotherapy needles.

  • Banding devices.

  • Heater probes.

  • Electrocautery probes.

  • Balloon-dilation devices.

  • Guidewires and wire-guided bougie dilators.

• • Anesthesia complications.

  • Bleeding.

  • Perforation.

• • 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.

  • • Hemoglobin levels.

    • Platelet count.

    • Prothrombin time.

    • Partial thromboplastin time.

  • 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.

• • Left lateral decubitus.

  • Supine.

• • The esophagus is divided into proximal, middle (8–10 cm above the gastroesophageal junction), and distal regions.

  • 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.

• • Administer oxygen by nasal cannula.

  • Start intravenous sedation or gas anesthesia via an endotracheal catheter.

  • • Sedation options include midazolam plus fentanyl or meperidine for conscious sedation, propofol, or general anesthesia.

  • Topical anesthesia is sprayed into the oropharynx.

  • Vital signs are monitored ...