Skills – Gastroscopy

“Drop in” gastroscopy outpatient clinic – experience after 9 months

– To evaluate or follow up peptic ulcer disease. – To position enteral feeding tubes. – For a variety of interventions such as removing foreign bodies, stricture dilatation and stenting, banding or injecting oesophageal varices, and laser therapy. – Contraindications: severe cardiac and chest complaints, abnormal coagulation, liver cirrhosis. – Take a full medical history from the patient. – Explain the procedure and gain informed consent. – Patient is nil by mouth for four to six hours before the procedure. – Patients should be offered the choice of intravenous sedation or local lignocaine throat spray. Sedation is given in incremental doses with time given to assess the effect of the sedation. – The patient is positioned in the left lateral position, head slightly flexed and a mouth guard is inserted. – The equipment is checked. Oxygen is on hand if necessary. – The endoscope is lubricated and inserted into the mouth guard, over the tongue to the oropharynx. The patient is asked to swallow to assist the advancement of the endoscope. – The endoscope is passed down the oesophagus, through the lower oesophageal sphincter and into the stomach.

i was reading this http://www.nursingtimes.net/nursing-practice/clinical-zones/gastroenterology/skills-gastroscopy/205528.article

Sign up “Drop in” gastroscopy outpatient clinic – experience after 9 months Gert Huppertz-Hauss*, Lubomir Chengarov, Stein Dahler, Anita Jrgensen, Volker Moritz, Jrn Paulsen and Geir Hoff * Corresponding author: Gert Huppertz-Hauss Gert.Huppertz-Hauss@sthf.no Department of Gastroenterology, Medical Clinic, Telemark Hospital, 3710 Skien, Norway For all author emails, please log on . For the patient, “drop in” gastroscopy may reduce uncertainty, inadequate therapy and time off work. Methods After an 8-9 month run-in period we asked patients, hospital staff and GPs to fill in a questionnaire to evaluate their experience with “drop in” gastroscopy and gastroscopy by appointment, respectively. The diagnostic gain was evaluated. Results 112 patients had “drop in” gastroscopy and 101 gastroscopy by appointment. The number of “drop in” patients varied between 3 and 12 per day (mean 6.5). Mean time from first GP consultation to gastroscopy was 3.6 weeks in the “drop in” group and 14 weeks in the appointment group. The half-yearly number of outpatient gastroscopies increased from 696 before introducing “drop in” to 1022 after (47% increase) and the proportion of examinations with pathological findings increased from 42% to 58%. Patients and GPs expressed great satisfaction with “drop in”. Hospital staff also acclaimed although it caused more unpredictable working days with no additional staff. Conclusions “Drop in” gastroscopy was introduced without increase in staff. The observed increase in gastroscopies was paralleled by a similar increase in pathological findings without any apparent disadvantages for other groups of patients. This should legitimise “drop in” outpatient gastroscopies, but it requires meticulous observation of possible unwanted effects when implemented.

read review http://www.biomedcentral.com/1471-230X/12/12/abstract