Endoscopy

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(the Endoscopist Reference page describes queue management, pathology orders, etc.)


Only diagnostic, screening, and surveillance endoscopy procedures are performed in Bethel. Patients needing therapeutic procedures, whether routine or urgent, require referral to a higher level of care.

Endoscopy is only performed for low-risk patients. Therefore patients must meet the YKHC Low-Risk Endoscopy Criteria. The lower age-cutoff for endoscopy is variable and dependent upon the patient's anticipated anatomy as well as the endoscopist's comfort level. Most endoscopists are comfortable performing procedures on teens who have essentially adult anatomy, regardless of chronological age.


Outpatients

Screening, surveillance, and diagnostic procedures are offered for outpatients. Patients should be referred after their comorbidities are well controlled and meet the YKHC Low-Risk Endoscopy Criteria.


Inpatients

Only diagnostic procedures are offered for inpatients. There should be sound rationale for why the procedure should not be postponed until the patient has been discharged and has subsequently returned to their normal baseline health status.

The risk/benefit ratio for screening does not justify performing procedures when patients are below their baseline health status (which is almost certainly the case for any inpatient).


EGD

Diagnostic and surveillance EGD's are performed. Screening EGD's are controversial and should be discussed with an endoscopist prior to referral. If ordered, the referral should specify that the patient be scheduled with the endoscopist who has agreed to do the case.

Like many circumpolar populations, Alaska Natives have a very high prevalence of gastric H. pylori and an alarming rise in drug resistance. This has major implications for the diagnosis and treatment of H. pylori in this populations. Please review the Helicobacter pylori in Alaska Natives page prior to diagnosing or treating H. pylori in this population.


Colonoscopy

Diagnostic, screening, and surveillance colonoscopies are performed.


Urgent Cases

Endoscopy can be performed Monday through Friday. Urgent diagnostic cases, from either the ER or inpatient, can frequently be added for later in the day or the next morning. This is initiated by contacting the endoscopist. If unknown, the endoscopist availability and contact information can be found by paging the OR charge nurse.


Viewing Endoscopy Images

Images are [usually] processed and uploaded into the patient's chart at the end of the procedural day, but low staffing or emergency procedures can result in deviations from the normal routine. Images are uploaded as a PDF file into the Multimedia manager under the "Telemed/Clinical Photos" folder. The image filenames begin with "EndoPics_" followed by the date in the YYYYMMDD format. Double-click the file to view it in Acrobat Reader.


Endoscopy Orders

For patients who meet the YKHC Low-Risk Endoscopy Criteria and need a diagnostic, screening, or surveillance procedure, a Bethel endoscopy can be ordered with "Refer to Adult Surgery Internal - YK EGD" or "Refer to Adult Surgery Internal - YK Colonoscopy".

For patients who do not meet the YKHC Low-Risk Endoscopy Criteria or who need a therapeutic procedure, endoscopy can be ordered with "Refer to Adult Surgery External".

When ordering endoscopy, please provide as much information as possible in the comments tab of the order. Though a little more work at the time of the order might seem inefficient, it is even more inefficient when it must be done by a case manager and/or endoscopist who does not have the patient in front of them, the patient's chart open, or clairvoyance into the mind of the orderer.

The Example Endoscopy Orders page discusses efficient and effective endoscopy orders.

For diagnostic procedures, please confirm that the patient has not already undergone the requested procedure for the same symptoms. For example, if the patient had an EGD 6mos and 18mos prior for the same dyspepsia symptoms, the likelihood of benefit from an additional EGD is exceptionally low. Alternatively, if a chronic condition has worsened and is associated with new, serious symptoms, then a repeat procedure is frequently indicated and the order should briefly describe the new symptoms and the date of the associated chart note[s]. In the case of ambiguity, please consult an endoscopist.