OGDS and Colonoscopy

As Housemen, you need to know about the indications, preparations, complications

Oesophagogastroduodenoscopy (OGDS)


Indications :


1) For investigation of :

Dyspepsia
Upper GI symptoms not responsive to optimal treatment
Patients >45 yrs with alarmic dyspeptic symptoms, eg :

Chest pain
Odynophagia
Weight loss
Anemia, evidence of GI bleeding
Dysphagia

Dysphagia/Odynophagia
Unexplained iron deficiency anemia
GI bleeding (Acute/Recent/Occult)
Re-evaluation of previous upper GI bleeding
Confirmation of radiologically demonstrated lesion
Suspected portal hypertension
Surveillance of tissue/fluid sampling (Barrett's/Polyposis)

2) Therapeutic interventions

On-going upper GI bleeding (variceal for eg)
Variceal treatment
Removal of selected polyps

Removal of foreign bodies
Dilatation of stenotic lesions
Placement of feeding tube

Palliative treatment for neoplasm

Preparation :


1) Informed consent
2) Patient may need to stop anti-platelet medications (aspirin, clopidogrel) 1 week prior to procedure, and diabetic medication 1 day before procedure
3) Antibiotic prophylaxis for patients with :

Undergoing high-risk endoscopies : Dilatation of stenotic lesions, Variceal bleeding
Previous h/o of infective endocarditis, those with prosthetic heart valves

4) Nil by mouth at least 6 hours prior to procedure
5) Pre-procedural investigations :

FBC, Blood grouping/Cross matching, Coagulation profile, UPT, urinalysis, ECG and chest X ray

6) Sedative given before procedure (diazepam). Hence, ask patient not to come alone or don't drive after procedure.

Contraindications :

Uncooperative patients, Medically unstable patients, risk of perforation is high

Complications : Bleeding, infection, perforation, cardiopulmonary problems


Colonoscopy

Indications :

1) Investigation

Unexplained iron deficiency anemia

Altered bowel habits

Chronic diarrhoea

Inflammatory bowel disease

Lower GI bleeding for patients >40 yrs of age (occult blood is included)

2) Therapeutic

Removal of foreign bodies
Treatment of bleeding
Excision of polyps
Decompression/Megacolon/Volvulus

Preparations :

1) Informed consent
2) Patient may need to stop anti-platelet medications (aspirin, clopidogrel) 1 week prior to procedure, and diabetic medication 1 day before procedure
3) Antibiotic prophylaxis for patients with previous h/o of infective endocarditis, those with prosthetic heart valves
4) 2 days prior to procedure, avoid solid foods, take only food which are easily digestible, eg :

Porridge, Noodles in clear soup, Low Fibre food

5) 1 day prior to procedure, only fluids !

eg, Coffee/Tea without milk, Carbonated drinks (not reddish/purplish), Strained fruit juices

6) Laxatives taken 1 day prior to procedure (tablets bisacodyl)
7) Night before procedure - NIL BY MOUTH
8) Day of procedure - try to empty bowel before procedure
9) Sedative given.