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Skin: Resilience
Published in Philip Berry, Necessary Scars, 2021
A gastroenterology registrar who believes that she is ready to deal with bleeding ulcers receives a phone call. A patient is bleeding in the ED. She makes arrangements to bring the patient to the endoscopy unit. She decides not to call her consultant because he has said on several occasions that she is ready. He has ‘signed her off’. The patient now awaits her; she takes the endoscope and passes it into his mouth. She finds the ulcer quickly and knows what to do. But it is bleeding rapidly, and the views that she obtains are not very clear. She knows what to do. She washes the ulcer, tries to clean the blood away, but still it bleeds. She begins to feel nervous… even more nervous. She asks for a needle with which to inject adrenaline, hoping that this will slow the bleeding down. Then she might see enough to apply some definitive therapy, a clip or thermal coagulation.
Sources of Medical Information
Published in Julie Dickinson, Anne Meyer, Karen J. Huff, Deborah A. Wipf, Elizabeth K. Zorn, Kathy G. Ferrell, Lisa Mancuso, Marjorie Berg Pugatch, Joanne Walker, Karen Wilkinson, Legal Nurse Consulting Principles and Practices, 2019
Patricia J. Bartzak, Deborah Enicke, Patricia Ann “Stormy” Green
Surgical procedures are performed in an operating suite. Other invasive procedures may take place in the radiology department, endoscopy unit, intensive care unit, or the pre-operative area. The provider who performed the surgery or procedure completes a procedure report, which must be completed within the period mandated by the facility’s policies and procedures. For surgical procedures, the surgeon completes an interim operative report to ensure skilled care in the post-operative period and transition to next level of care (The Joint Commission, 2018b).
Introduction to specialist investigations and procedures
Published in Louisa Baxter, Neel Sharma, Ian Mann, The Junior Doctor’s Guide to Gastroenterology, 2018
Louisa Baxter, Neel Sharma, Ian Mann, Ian Sanderson
Thorough bowel preparation prior to colonoscopy is a critical first step in ensuring a technically adequate study. Even small amounts of retained faecal matter can obscure the distal lens of the endoscope. Endoscopy units have different regimens, and it is therefore advisable that you discuss this with your endoscopy unit.
Colonoscopy performance monitoring: do we need to adjust for case mix?
Published in Scandinavian Journal of Gastroenterology, 2023
Lasse Pedersen, Inge Bernstein, Karen Lindorff-Larsen, Charlotte Carlsen, Thomas Gerds, Christian Torp-Pedersen
Since the study was conducted in a real-world setting with multiple endoscopy units and with routine diagnostic and screening colonoscopies, we believe that the results are generalisable. However, endoscopy unit setups and screening programmes vary between countries and jurisdictions which may affect the external validity. Our colonoscopy indication variable had just two categories, whereas other studies have used three or four different categories [4,5]. Since our study did not include colonoscopies performed within the gastroenterology jurisdictions, homogeneity within our two categories are likely comparable to that of other studies. Even so, the lack of colonoscopies performed within the gastroenterology jurisdiction is a limitation. Colonoscopies within the gastroenterology jurisdiction are usually performed on individuals suspected of inflammatory bowel disease, generally a younger age group with a different PDR [1]. The definition of ‘screening’ varies as some screening programmes rely on a positive faecal immunochemical test before referral for colonoscopy, whereas other programmes apply colonoscopy as the primary screening tool [30]. A study by Cubiella et al. found a 31% ADR using primary colonoscopy screening and a 55% ADR when colonoscopy was preceded by a positive faecal immunochemical test [31]. The high ADR when using faecal immunochemical test screening leads to a high OR when comparing screening versus diagnostic colonoscopies and magnifies the effect of differences in endoscopist case mix.
Endoscopic therapy of sporadic non-ampullary duodenal adenomas, single centre retrospective analysis
Published in Scandinavian Journal of Gastroenterology, 2023
Marianne Udd, Outi Lindström, Andrea Tenca, Mia Rainio, Leena Kylänpää
In the endoscopy unit, a polyp removal procedure by six experienced endoscopists was performed under conscious sedation provided by an anaesthesiologist and anaesthesia nurse. Patients were either in a prone or in a left lateral cubitus position. Glucagon (GlucaGen®, Novo Nordisk Farma, Espoo, Finland) or hyoscine-N-butylbromide (Buscopan®, Sanofi, Espoo, Finland) were administered to inhibit duodenal motility. Snare polypectomy or EMR was primarily used. Saline or Sigmavisc®, were injected for lifting. When snare polypectomy was not technically possible (scarring or position of the adenoma) an endoscopic band ligation (EBL) device (6 shooter® Cook Medical, Helsinki, Finland) was used, and an endoloop (Polyloop ligating device, Olympus, Espoo Finland) placed in cases of pedunculated polyps. In cases of periprocedural bleeding, coagulation with flushing monopolar probe, hot biopsy or haemostatic clips were used. Successful endoscopic treatment was defined as the absence of visible residual adenoma at the end of the endoscopic resection. Residual adenoma was defined as visible adenoma remnant at first control and recurrent adenoma was defined as adenoma recurs after a period adenoma could not be detected. Patients were followed up until they recovered from sedation and most patients had same-day discharge. However, next-day discharge was required if the patient did not have an adult caretaker at home for the following 24 h or if the patient suffered from any complications.
Spectrum and pattern of distribution of findings in patients with dyspepsia undergoing oesophago-gastro-duodenoscopy at a Tertiary Hospital in Ibadan, south west, Nigeria
Published in Alexandria Journal of Medicine, 2021
Kolawole Oluseyi Akande, Temitope Olufemi Oke, Oludolapo Afuwape, Tinuola Abiodun Adigun, Adegboyega Akere, Ajibola Aje, Samuel Olawale Ola, Jesse Abiodun Otegbayo
Study site: The study was carried out at the endoscopy suite of UCH, Ibadan, Nigeria. UCH, Ibadan is the Nigerian Premier University Hospital established 62 years ago with 1000 in patients’ beds. The endoscopy suite has two functioning procedure rooms equipped with EVIS EXERA 111 Olympus video-endoscopy system since 2012. Scheduled OGD were done 3 days in a week for both outpatients and in patients while emergencies are done every day. Patients were referred for OGD from different clinics within and outside UCH. Referrals for endoscopy are also received from neighboring states of Ogun, Ondo and Osun states. The Endoscopy unit had Seven Consultant Medical and Surgical Gastroenterologists who have experience in gastrointestinal endoscopy spanning between 5 and 31 years. A pre-endoscopy assessment was done for all the patients to ascertain the indication for the procedure, ensure there was no contraindication(s) and obtain an informed written consent. The usual premedication was 10% xylocaine pharyngeal spray with or without intravenous midazolam depending on the preference of the Endoscopist and the patients’ comorbidities. Occasionally, ketamine and/or propofol was used for patients with history of allergy to xylocaine, very anxious patients, or those who preferred deep sedation despite adequate counseling that the procedure is usually done with conscious sedation. Each patient’s report was generated after the procedure and an electronic copy was stored in the desktop computer in each of the procedure room.