Mark McAlindon Gastroenterology Diagnostic endoscopy Mark McAlindon Gastroenterology

The gastrointestinal tract

GI endoscopy Gastroscopy Colonoscopy Oesophagogastroduodenoscopy (OGD) Colonoscopy Flexible sigmoidoscopy Endoscopic retrograde cholangiopancreatography (ERCP) Capsule endoscopy Double balloon enteroscopy

GI endoscopy Diagnostic Therapeutic

OGD Local anaesthetic Light sedation Lignocaine spray Maintain verbal communication Ptosis: deep sedation Midazolam T1/2 15 mins amnesia

Complications Cardiopulmonary 0.1% risk of bleeding or perforation 50% of all complications Often related to oversedation 0.1% risk of bleeding or perforation

Indications Dyspepsia Dysphagia Anaemia Suspected coeliac disease Upper abdominal pain or discomfort >55 years Dysphagia Anaemia Suspected coeliac disease Duodenal biopsies Screening for varices in liver disease

Gastro-oesophageal reflux (GORD) Heartburn Acid reflux Dysphagia Extra-oesophageal manifestations Hoarseness Cough wheeze Sore throat Dental erosions

Gastro-oesophageal reflux

Peptic ulcers Pain Bleed Perforation

Oesophageal carcinoma Adenocarcinoma GORD Barrett’s oesophagus Oesophagitis Obesity Squamous cell carcinoma Smoking Alcohol Poor diet Symptoms Dysphagia Odynophagia

Coeliac disease

Panreaticobiliary disease

ERCP Pancreatitis 10% Post sphincterotomy bleed 1-2%

Indications Usually follows MRCP Biliary obstruction i.e predominantly a therapeutic procedure Biliary obstruction

Colonoscopy Light sedation Analgesia Nitrous oxide Midazolam Fentanyl Synergistic effect Small dose, given first Nitrous oxide Entonox

Indications Altered bowel habit Diarrhoea +/- bleeding Anaemia

Complications Cardiopulomonary 0.1% risk of perforation or bleeding 50% of all complications Often related to oversedation 0.1% risk of perforation or bleeding http://www.bsg.org.uk/images/stories/docs/clinical/guidelines/endoscopy/complications.pdf

Colon cancer

Diagnosis Colonoscopy Barium enema Virtual CT colonography

Capsule endoscopy

Indications Suspected small bowel bleeding Suspected Crohn’s disease Non contributory gastroscopy & colonoscopy Suspected complication of coeliac disease Peutz Jegher’s syndrome

Complications 1% capsule retention overall Higher in Known Crohn’s disease Previous irradiation Long term NSAID use Consider prior radiology or dissolvable patency capsule to ensure luminal patency

Double balloon enteroscopy 1-2% complication rate Perforation Pancreatitis Bleeding

The gastrointestinal tract

Extra-intestinal manifestations of IBD System Diagnosis Skin Erythema nodosum, pyoderma gangrenosum, mouth ulcers Eyes Iritis, episcleritis Joints Arthropathy, peripheral arthritis, sacroiliitis, ankylosing spondylitis Liver Primary sclerosing cholangitis (UC), autoimmune hepatitis, cirrhosis Vascular Thromboses

Peptic ulcer diagnosis and treatment Clinical history H pylori test Urease breath test Faecal antigen test Gastroscopy Barium meal Stop NSAID Proton pump inhibitors H pylori eradication Antibiotics + PPI

Coeliac disease Diarrhoea Weight loss ‘Irritable bowel’ Anaemia Steatorrhea Weight loss ‘Irritable bowel’ Anaemia Mouth ulcers Abnormal liver function Serology Anti-endomysial antibodies Anti-tissue transglutaminase antibodies Gastroscopy Duodenal biopsies

Crohn’s disease Ulcerative colitis Anywhere, but small bowel common Only affects colon Pain, diarrhoea and weight loss Diarrhoea and bleeding Fistula, mass, abscess Perianal disease Skip lesions Continuous inflammation Transmural inflammation Mucosal inflammation Epithelioid granulomas