Gastrointestinal Endoscopy¶

** · Part 10 – Gastrointestinal Disorders · Chapter 333

Key Clinical Points¶

Harrison's 22e, p.2482

PATIENT CONDITION	PROCEDURE CONTEMPLATED	GOAL OF PROPHYLAXIS	PERIPROCEDURAL ANTIBIOTIC PROPHYLAXIS
All cardiac conditions	Any endoscopic procedure	Prevention of infective endocarditis	Not recommended
	ERCP with complete drainage	Prevention of cholangitis
Bile duct obstruction in the absence of cholangitis	ERCP with anticipated incomplete drainage (e.g., sclerosing cholangitis, hilar strictures)	Prevention of cholangitis	Recommended; continue antibiotics after the procedure
	ERCP	Prevention of cyst infection
Sterile pancreatic fluid collection	Transmural drainage	Prevention of cyst infection	Recommended
	EUS-FNA or FNB	Prevention of local infection
Solid lesion along lower GI tract	EUS-FNA or FNB	Prevention of local infection	Not recommendeda
	EUS-FNA or FNB	Prevention of cyst infection
All patients	Percutaneous endoscopic feeding tube placement	Prevention of peristomal infection	Recommendedb
	Recommended for all such patients, regardless of endoscopic procedures	Prevention of infectious complications and reduction of mortality
Continuous peritoneal dialysis	Lower GI tract endoscopy	Prevention of bacterial peritonitis	Recommended
	Any endoscopic procedure	Prevention of graft and device infection
Prosthetic joints	Any endoscopic procedure	Prevention of septic arthritis	Not recommendedd

Harrison's 22e, p.2483

DRUG	BLEEDING RISK OF PROCEDURE	MANAGEMENT	INTERVAL BETWEEN LAST DOSE AND PROCEDURE	COMMENTS
Warfarin	Lowa	Continue	N/A	Ensure that INR is not supratherapeutic
	Highb	Discontinue	3–7 days (usually 5), INR should be ≤1.5 for procedure	Consider bridging therapy with low-molecular-weight heparin for patients at high risk of thrombosisc; usually safe to resume warfarin on the same or next day For life-threatening GI hemorrhage, consider reversal with unactivated prothrombin complex concentrate
	Lowa	Hold morning dose on day of procedure	N/A
Dabigatran	Highb	Discontinue	2–3 days if GFR is ≥50 mL/min, 4–5 days if GFR is 30–49 mL/min	Bridging therapy not recommended; resume drug when bleeding risk is low For life-threatening GI hemorrhage, consider use of a reversal agent
	Higha	Discontinue	2 days if GFR is ≥60 mL/min, 3 days if GFR is 30–59 mL/min, 4 days if GFR is <30 mL/min
Heparin	Lowa	Continue	N/A
	Highb	Discontinue	4–6 h for unfractionated heparin	Skip one dose if using low-molecular-weight heparin
	Any	Continue	N/A
Aspirin with dipyridamole	Lowa	Continue	N/A
	Highb	Discontinue	2–7 days	Consider continuing aspirin monotherapy
	Lowa Highb	Continue Coronary stent in place: discuss with cardiologist No coronary stent: discontinue, consider substituting aspirin	N/A 5 days (clopidogrel or ticagrelor), 7 days (prasugrel), 10–14 days (ticlopidine)

Harrison's 22e, p.2502

	CHOICES/RECOMMENDATIONS	COMMENTS
Average-Risk Patients
Asymptomatic individuals between 45 and 75 years of age	Colonoscopy every 10 yearsa	Gold standard cancer prevention strategy
	Multitargeted stool DNA test every 1–3 years FIT or HSgFOBT every year, with or without flexible sigmoidoscopy every 10 years	Less sensitive than colonoscopy; colonoscopy if results are positive Less sensitive than colonoscopy; colonoscopy if results are positive
	CT colonography every 5 years	Colonoscopy if results are positive
	Flexible sigmoidoscopy every 5 years	Does not detect proximal colon polyps and cancers; colonoscopy if an adenomatous polyp is found
Asymptomatic individuals > 75 years of age	Selective screening	Consider patient’s overall health, results of previous screening exams, and preferences
Personal History of Polyps or CRC
Inflammatory Bowel Disease
Long-standing (>8 years) ulcerative pancolitis or Crohn’s colitis, or left-sided ulcerative colitis of >15 years’ duration	Colonoscopy with biopsies every 1–2 years	Consider chromoendoscopy or other advanced imaging techniques for detection of flat dysplasia during colonoscopy
Family History of Polyps or CRC