What pre-procedure labs and post-procedure care are recommended for a patient undergoing endoscopy, including speech pathology consultation as requested by Gastroenterology (GI)?

Pre-Procedure Labs and Post-Procedure Care for Endoscopy

For patients undergoing endoscopy, routine pre-procedure SARS-CoV-2 testing is not recommended, and post-procedure care should include monitoring for complications, a speech pathology consultation as requested by GI, and specific patient instructions regarding activity restrictions and diet progression.

Pre-Procedure Assessment and Labs

Pre-Procedure Questionnaire

• Complete health questionnaire documenting:
  • General health status
  • Recent health changes
  • Medical history (heart disease, stroke, lung problems, liver disease, hypertension, diabetes, bleeding disorders, seizures) 1
  • Current medications (including OTC and supplements)
  • Allergies
  • Family history of anesthesia/sedation complications 1

Laboratory Testing

• No routine pre-procedure SARS-CoV-2 testing is recommended regardless of vaccination status (conditional recommendation, very low certainty evidence) 1
  • Centers that choose to implement testing should use standard nucleic acid testing (laboratory-based NAAT or rapid RT-PCR) rather than rapid isothermal or antigen tests 1
  • All patients should undergo symptom-based screening for COVID-19 before endoscopy 1

Post-Procedure Care

Immediate Recovery

• Position patient on their side for up to 2 hours after the procedure 1, 2
• Monitor vital signs regularly (pulse, blood pressure, temperature) 1
• Continue oxygen supplementation and pulse oximetry monitoring into the recovery period 1
• Observe for signs of complications (pain, breathlessness, fever, tachycardia) 1

Diet Progression

1. Begin with small sips of water when patient is awake and alert 1, 2
2. If water is tolerated without pain or coughing, progress to larger amounts of fluids 1, 2
3. If fluids are tolerated well, patient may return to normal diet the same day 1, 2
4. Report any pain or distress immediately to the medical team 1

Speech Pathology Consultation

• Implement the speech pathology consultation as requested by GI
• This is particularly important for patients who may have:
  • Difficulty swallowing (dysphagia)
  • Risk of aspiration
  • Need for assessment of swallowing function after endoscopic procedures

Discharge Instructions

• Patient must be accompanied home by a responsible adult if discharged within 24 hours 1, 2
• Provide written instructions including:
  1. No driving or operating machinery for 24 hours 1, 2
  2. No alcohol consumption for 24 hours 1, 2
  3. Rest for the remainder of the day 2
  4. Expectation of possible sore throat for 24-48 hours 1, 2
  5. When to seek medical attention (severe pain in neck, chest, or abdomen) 1, 2
  6. Contact information for emergency situations 1

Monitoring for Complications

Warning Signs Requiring Immediate Attention

• Persistent pain (chest, neck, or abdomen)
• Breathlessness
• Fever
• Tachycardia
• Difficulty swallowing or pain when swallowing 1, 2
• Coughing when attempting to drink 2

Potential Complications

• Perforation (overall rate 2.6%, higher in malignant strictures at 6.4%) 1
• Pulmonary aspiration
• Bleeding 1

Special Considerations

For Specific Procedures

• After esophageal dilatation, particularly for achalasia:
  • Consider chest x-ray and contrast study to exclude perforation
  • Longer observation period may be needed (overnight) 1

High-Risk Patients

• Elderly patients appear to be at higher risk for complications 1
• Patients with complex strictures require more careful monitoring 1

Common Pitfalls to Avoid

• Discharging patients too early before adequate recovery
• Failing to provide written discharge instructions
• Not arranging for a responsible adult to accompany the patient home
• Missing signs of perforation (persistent pain, breathlessness, fever, tachycardia)
• Allowing patients to drive or operate machinery within 24 hours of the procedure

By following these guidelines, you can ensure proper pre-procedure assessment and post-procedure care for patients undergoing endoscopy, including implementing the speech pathology consultation as requested by the gastroenterology team.