1. Mark McAlindon Gastroenterology
Diagnostic endoscopy
Mark McAlindon
Gastroenterology

2. The gastrointestinal tract

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

4. GI endoscopy
Diagnostic
Therapeutic

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

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

7. 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

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

9. Gastro-oesophageal reflux

10. Peptic ulcers
Pain
Bleed
Perforation

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

12. Coeliac disease

13. Panreaticobiliary disease

15. ERCP
Pancreatitis 10%
Post sphincterotomy bleed 1-2%

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

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

18. Indications
Altered bowel habit
Diarrhoea +/- bleeding
Anaemia

19. Complications Cardiopulomonary 0.1% risk of perforation or bleeding
50% of all complications
Often related to oversedation
0.1% risk of perforation or bleeding

22. Colon cancer

23. Diagnosis
Colonoscopy
Barium enema
Virtual CT colonography

24. Capsule endoscopy

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

26. 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

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

28. The gastrointestinal tract

30. 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

32. 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

33. 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

34. 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