Chapter 88 Endoscopy
Fiberoptic endoscopy of the upper and lower intestines is used for the diagnosis and treatment of a variety of intestinal diseases. Endoscopy provides visualization of the mucosa of the gastrointestinal (GI) tract, allows tissue samples to be obtained (biopsy), and permits performance of therapeutic procedures. Upper intestinal tract endoscopy allows direct visualization of the esophagus, the stomach, and the duodenum. Indications for an upper intestinal tract endoscopy include prolapsed gastropathy, “a more accurate description of an old and possibly common cause of upper gastrointestinal bleeding in children” (Gilger, 2001), vomiting, failure to thrive, recurrent abdominal pain, ingestion of foreign body or caustic substance, and stricture. Lower intestinal tract endoscopy allows the physician direct visualization of the mucosa of the colon. Indications for colonoscopy include bleeding, chronic inflammatory bowel disease, and chronic diarrhea. There are few contraindications to endoscopy, and it is most often performed in an outpatient setting. Conscious sedation is used not only to sedate but also to minimize discomfort during the procedure. Complaints of sore throat and neck pain are usually mild and of no consequence. Some children may feel some soreness in their abdomen the day after the procedure. Adverse effects of endoscopy include but not limited to the following: infection, allergic and/or adverse reaction to anesthesia, aspiration, bleeding, and perforation of the GI tract.
There is an increased trend in the therapeutic use of endoscopy in children. These include pediatric endoscopic retrograde cholangiopancreatography to diagnose infant cholestasis, endoscopic treatment of pancreatitis, and antireflux operations (endoscopic fundoplication). Computer-assisted virtual endoscopy and the wireless videoendoscope are also now available for the pediatric population.
Computer-assisted virtual endoscopy and the wireless videoendoscope may soon replace conventional endoscopy as a diagnostic tool. Advances in medical technology contribute to enhanced performance of newer capsule endoscopy for children; for example, providing improved visualization of the small bowel mucosa and higher diagnostic yield. Administration of sedation or use of contrast media or anesthesia is not necessary.
NURSING INTERVENTIONS
1. Explain procedure to child and caregivers before it is performed.
2. Monitor vital signs, including oxygen saturation, during and after procedure.
3. Ensure proper positioning of child.
4. Assist with airway maintenance.
5. Observe for evidence of bleeding or excessive abdominal pain and/or distention.
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Perlstein PH, et al. Implementing an evidence-based acute gastroenteritis guideline at a children’s hospital. Jt Comm J Qual Improv. 2002;28(1):20.
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