Fiber Optic Endoscopy: Gastroscopy
Flexible endoscopy of the upper gastrointestinal tract is a major diagnostic and therapeutic tool for rural surgeons. The procedure is part of preoperative assessment and treatment planning, allows for intraoperative evaluation of the surgical site and is
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Fiber Optic Endoscopy: Gastroscopy Matthias W. Wichmann and Fritz W. Spelsberg
7.1 Introduction Flexible endoscopy is a significant part of the everyday workload of most general surgeons. The ongoing development of this technology has contributed to significant reduction of access trauma in most surgical specialties as well as in general surgery. Flexible endoscopy is part of preoperative assessment and treatment planning; it allows for intraoperative evaluation of the surgical site (i.e., anastomosis after resection, width of esophagus after fundoplication) and is part of the management of post-operative complications (i.e., stenting of fistulas, dilatation of stenoses, washout of anastomotic leakage). The endoscopic treatment of early stages of gastro-intestinal cancers has been established, as well as the useful application of flexible endoscopy during so-called rendezvous procedures with minimal invasive surgery (i.e., resection of gastro-intestinal stroma tumors). Moreover, interventional endoscopy plays a major role in the palliative treatment of a number of advanced tumors within the gastro-intestinal tract and allows for maintenance of normal food passage and control of local complications such as blood loss or fistula formation.
M.W. Wichmann (*) Department of General Surgery, Mount Gambier General Hospital and Flinders University Rural Medical School, 276-300 Wehl Street North, Mount Gambier, SA 5290, Australia e-mail: [email protected] F.W. Spelsberg Department of Surgery, University of Munich – Campus Grosshadern, Marchioninistr. 15, 81377 Munich, Germany
7.2 Upper Gastro-Intestinal Tract Endoscopy/Gastroscopy 7.2.1 Indications Flexible endoscopy of the upper gastro-intestinal tract is indicated when a known or suspected disease of the esophagus, stomach, or duodenum requires further investigation. Common indications for endoscopy of the upper gastro-intestinal tract are listed in Table 7.1.
7.2.2 Patient Preparation and Technique of Examination The patient needs to be informed about the risks and indication for the endoscopy and should be fasted for a minimum of 6 h. Anticoagulation therapy does not need to be stopped unless a more invasive intervention than biopsy is planned. The procedure is carried out with the patient lying on the left side. Usually, local anesthetics can be applied with a spray into the larynx (Xylocaine spray). Local anesthesia should not be applied in a not-fasted emergency patient since it increases the risk of aspiration. If the patient is sedated (Midazolam 3–5 mg i.v. or Disoprivan 50–70 mg bolus + maintenance boli of 10–30 mg i.v.), pulseoxymetry is mandatory for monitoring. The use of Disoprivan also requires the presence of a second physician during the investigation. The need of sedation for upper GI endoscopy can be discussed with the patient prior to surgery and should consider the
M.W. Wichmann et al. (eds.), Rural Surgery, DOI: 10.1007/978-3-540-78680-1_7, © Springer-Verlag Berlin Heidelberg 2011
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M.W. Wichmann and F.W. Spe
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