YKHC Low-Risk Endoscopy Criteria

OVERVIEW

Because YKHC has no ICU, serious endoscopy complications require transfer to the Emergency Department and/or Medevac transfer. Prevention of this occurrence is a priority. Therefore endoscopy in Bethel is limited to low risk patients.

The intention of this page is to provide transparent criteria for the most common conditions which increase the risk of an endoscopy complication. This page is not all-inclusive.

These criteria are written with isolated diagnoses in mind. The presence of multiple comorbidities may yield a higher risk than either individually and this effect is not incorporated into these criteria.

The intention of these criteria is to risk stratify based on the functional status of a disease rather than its mere mention in a patient's chart.

GENERAL

BMI

• BMI < 45 (non-negotiable limit)

- for BMI 40-45: anesthesia approval (for non-Bethel patients this should occur PRIOR to ordering)

Acute Illnesses

Patients should be at their baseline health status for outpatient endoscopy in Bethel.

Acute illness is a contraindication for Bethel endoscopy unless the illness is mild and does not involve the nasopharynx, gastrointestinal system, or cardiopulmonary system. Fever or acutely abnormal vital signs are a contraindication. Additionally, patients must be comfortable laying on their side and extending their neck.

Urgent inpatient procedures require discussion with and approval by the endoscopist and the anesthetist. It is accepted that these patients are not at their baseline, but the urgency of the condition frequently necessitates prompt performance of the procedure.

CARDIAC

CHF

1. Most recent LVEF >= 40%
2. Recent (<6mos) BNP <= 125 pg/mL (or YKHC laboratory’s current upper limit of normal)
3. No loop diuretic use (chronic or acute) within the last 12 months
4. No current or recent cardiac-like symptoms which have not been thoroughly investigated

CAD

1. No history of coronary revascularization (either surgical or endovascular)
2. No use of anti-angina agents in the last 12 months
3. Normal cardiac stress test within the last 12 months
4. No current or recent cardiac-like symptoms which have not been thoroughly investigated

A-Fib

1. Currently in sinus rythm
2. No subjective or objective A-Fib occurrence within 12 months
3. No use of anti-arrythmic drugs within 12 months
4. Meets all of the "CHF" criteria above
5. No current or recent cardiac-like symptoms which have not been thoroughly investigated

PULMONARY

Asthma

Prior to endoscopy (and preferably prior to the referral), asthma severity should be classified in accordance with the Guidelines for the Diagnosis and Management of Asthma (EPR-3).

Asthma Classification Resources:

• Asthma Care Quick Reference is a summary of the above guideline.
• CheatSheets for asthma classification (pages 5, 6, and 7 from the Quick Reference).
• Asthma Control Test is a quick, simple, validated questionnaire for patients to complete.

Endoscopy will only be performed upon asthma patients who meet these criteria:

• If treated, must meet criteria for Well Controlled asthma.
• If UNtreated, must meet criteria for Intermittent asthma.

COPD

• Post-bronchodilator FEV₁ >= 60% of predicted

  - order as "PFT (Pre-&Post-Albuterol) Eval"

  - view results in Multimedial Manager —> EKG Folder

OSA

• Positive pressure ventilation has NOT been recommended/prescribed
• Anesthesia approval (for non-Bethel patients this should occur PRIOR to ordering)

MEDICATIONS

Antiplatelets

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Anticoagulants

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Opioid Replacement Therapy

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