Definition
Upper Gastrointestinal Endoscopy refers to the visualization of the esophagus, stomach and duodenum by a flexible endoscope that permits biopsy, cytology study, pictures and video documentation.
Purposes
- To perform biopsy/cytologic study.
- To remove polyps and foreign bodies.
- To control bleeding.
- To open strictures.
Indications
- Chronic gastrointestinal (GI) bleeding.
- Pernicious anemia.
- Esophageal injury.
- Masses in Gl tract.
- Strictures.
- Dysphagia.
- Substernal pain.
- Epigastric discomfort.
- Neoplasms.
- Ulcer in upper GI tract.
- Esophageal and gastric varices.
- Gastroesophageal reflux disease.
Articles
Endoscopy tray/trolley
- Suction equipment.
- Resuscitation equipment.
- Mouth guard.
- Drugs as prescribed, syringes and needles.
- Adhesive tape.
- Lubricant jelly.
- Gloves, gown and mask.
- Specimen containers.
- Slides.
- Protective pad/mackintosh.
Preparation
Preparing for an upper gastrointestinal endoscopy involves several important steps to ensure the procedure is safe and effective:
- Fasting:
- Avoid eating or drinking for at least 6-8 hours before the procedure. This ensures the stomach is empty for clear visualization.
- Medication Adjustments:
- Inform your doctor about any medications you are taking, especially blood thinners or diabetes medications. You may need to adjust or temporarily stop them.
- Clothing and Accessories:
- Wear loose, comfortable clothing and avoid wearing jewelry or metallic items.
- Transportation:
- Arrange for someone to drive you home after the procedure, as sedation may impair your ability to drive.
- Health Disclosure:
- Inform your healthcare provider about any allergies, medical conditions, or previous reactions to sedation.
- Pre-Procedure Tests:
- Your doctor may recommend blood tests or other evaluations to ensure you are fit for the procedure.
Procedure
| Nursing action | Rationale | |
| 1. | Explain the procedure to the patient. | Allays anxiety and helps in obtaining cooperation. |
| 2. | Get informed consent from the patient. | Avoids medical legalities. |
| 3. | Keep patient nil per orally (NPO) for 8-12 hours. | Prevents aspiration of stomach contents into lungs and allows for complete visualization of stomach. |
| 4. | Assess the oral cavity and report any lesions or loose tooth. If dentures are present, remove it. | Dentures may cause obstruction during procedure and removal of dentures facilitates passing the scope and preventing injury. |
| 5. | Spray the throat with local anesthetic. | Suppresses gag reflex. |
| 6. | Intravenous sedative may be given. | Provides sedation and relieves anxiety during procedure. |
| 7. | Give injection atropine if ordered. | Reduces secretions. |
| 8. | Position patient in left lateral during procedure. | Left lateral position facilitates drainage of saliva and provides easy access for endoscope. |
| 9. | Lubricate the endoscope with water soluble jelly. | Makes insertion easy and avoids friction. |
| 10. | Explain that room will be cool and dark and the patient will not be able to speak when the scope is in place. | Allows patient to have realistic anticipation and reduces anxiety. |
| 11. | Place mackintosh below head and neck of patient. | Protects bed linen from soiling. |
| 12. | Place mouth guard in place. | Prevents patient from biting on scope. |
| 13. | Instruct patient to swallow while endoscope is being advanced.Once inserted, instruct patient that he will not be able to swallow, talk or move the tongue. | |
| 14. | Suction out and examine secretions from oral cavity as necessary. | Prevents risk of aspiration. |
| 15. | Monitor vital signs and oxygen saturation throughout the procedure. | Helps in early identification of complication if any. |
Postprocedural care
| Nursing action | Rationale | |
| 1. | Place the patient in Sim’s position. | Prevents aspiration due to anesthetic effect. |
| 2. | After the procedure continue NPO status until gag reflex returns. | |
| 3. | Provide lozenges or normal saline gargles. | Eases throat irritation and hoarseness. |
| 4. | Assess for signs of esophageal or gastric perforation. | Detects any complication if it occurs. |
| 5. | Provide complete bed rest for 1 hour. | Promotes comfort of patient. |
| 6. | Monitor patient for abdominal or chest pain, cervical pain, hematemesis, melena, distended abdomen, fever, light headedness and firm distended abdomen. | Indicates complications. |
| 7. | Monitor vital signs every 30 minutes for 3-4 hours and keep the patient in bed with side rails up. | |
| 8. | Record the procedure in nurse’s record including timing of the procedure, tolerance and patient’s reaction. | Gives information about the effectiveness of the procedure and any complications, if it occurs. |
Complications
- Perforation of the esophagus or stomach.
- Pulmonary aspiration.
- Hemorrhage.
- Respiratory depression.
- Infection.
- Cardiac arrhythmia.
Special Consideration
- Confirm the patient has followed pre-procedure instructions, such as fasting for 6-8 hours.
- Address any anxiety by explaining the procedure and its purpose clearly.
- Observe the patient closely for any adverse reactions to sedation or anesthesia.
- Ensure the patient’s airway remains unobstructed throughout the procedure.
- Maintain strict sterile conditions to minimize the risk of infection.
- Ensure the endoscope and all accessories are properly disinfected and functioning.
- Monitor the patient for complications, such as bleeding or perforation.
- Provide clear instructions for recovery, including dietary restrictions and follow-up care.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwers, ISBN-13:978-9388313285
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884
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