Hemostasis
Name 1 example of an upper GI bleed (not from a polyp removal)
Duodenal ulcer, AVM's, Mallory-Weiss tear, Dieulafoy Vascular Malformation
Why perform dilation?
Restore lumenal patency!
Allow patient ability to eat and drink normally
Allow access for additional procedures
Scope reprocessing standards and best practices are influnced by guidelines and professional bodies. Name 2 of societies/governing bodies:
SGNA, ASGE, AAMI, AORN, AAAHC, Joint Commission
What are the 2 classifcations/types of snares used in Endoscopy?
Hot, Cold
Liver, Pancreas, Gallbladder
Name 3 examples of Lower GI bleeds (not including polyp removal):
Diverticular disease; Ulcerative colitis; Colon angiodysplasia; Colon cancer
Where in the GI tract can a stricture form?
Esophagus, Gastric (Pylorus), Colon
Anywhere
Describe biofilm
Biofilm is a well-organized, cooperating community of microorganisms attached to living and inanimate surfaces
Why would a Doctor choose to use a cold snare?
Efficiency, lower risk of post polypectomy bleeding
Which organ stores bile?
Gallbladder
What is combination therapy in managing GI bleeds:
Using multiple modalities to safely and effectively limit recurring bleed risk
What is the name of a pyloric stricture
Gastric Outlet Obstruction
Name 2 of the reasons for visual inspection of the endoscope:
- ensures scope is visibly clean; inspects for cracks, corrosion, debris, discoloration; magnification and adequate lighting support close inspection; determine is re-cleaning is necessary; borescope inspection is necessary to assess inner working channel
Name 2 features physicians care about when deciding what snare to use:
List 2 reasons why a patient would need a biliary stent:
1.Biliary stricture
2.Bile duct leak
3.Failure to remove stones
Name 2 advantages of endoscopic hemoclips:
•Practicality, efficacy, and safety well-established
•Mechanical compression exerted by clipping causes less tissue damage and provides an anatomical marker.
•Lower morbidity than surgery for treatment of GI bleeding
•Reduces the risk of delayed bleeding in patients on anticoagulants and antiplatelet therapy
What is the rule of 3?
In a single session, no more than three dilators of sequentially larger size should be passed once moderate or greater resistance is evident. Dilators passed with no or mild resistance do not count toward this total.
What is the purpose of the cleaning adapter used during bedside endoscopy cleaning?
To force fluid down the air channel, preparing the scope for AER reprocessing. Without this step, no fluid is forced through the air channel of the endoscope.
What is EMR and why is it important?
Endoscopy Mucosal Resection
Removing cancer + having clean margins!
Name 2 malignant pancreaticobiliary diseases
Klatskin‘s tumor, Gallbladder cancer, Cholangiocarcinoma, Pancreatic cancer, Ampullary cancer
According to Dr. Pohl's study focusing on clip closure preventing bleeding after endoscopic resection of large polyps, in what percentage of patients can bleeding occur in the group that were not clipped:
Bonus 100 points: what was the rebleed rate in the clipped group of patients?
7.1%
Bonus: 3.5%
Why is negative pressure so important?
It retracts any air from the balloon and the catheter! Without it, the balloon might not evacuate and your Dr. will be upset!
Where do auditors often go first to assess the endoscope cleaning process when performing an inspection?
The scope hanging/storage cabinet, specifically the base under where the scopes hang to look for fluid residue or any signs of contamination.
What is ESD and why is it important?
Endoscopic Submucosal Dissection
Removing cancer, avoid surgery and ensuring clean margins!
Name 3 potential complications of ERCP and what is the highest risk:
Pancreatitis, biliary sepsis, bleeding, perforation, aspiration, cardiac or respiratory arrest