What is the pre-procedure patient education for a patient with epigastric pain undergoing an endoscopy?

Pre-Procedure Patient Education for Endoscopy in Patients with Epigastric Pain

Patients with epigastric pain undergoing endoscopy must receive comprehensive written and verbal information about the procedure, including its risks, benefits, and alternatives, with sufficient time to read and ask questions before the procedure day.1

Essential Information to Provide

Explanation of Condition and Procedure

• Explain the potential causes of epigastric pain, including GERD, gastritis, peptic ulcer disease, and less common but serious conditions like gastric cancer 2
• Describe the endoscopy procedure in plain language, including what the patient will experience before, during, and after 1
• Explain that endoscopy is the standard test of choice for evaluating epigastric pain to diagnose conditions like GERD, esophagitis, gastritis, and peptic ulcers 2

Preparation Requirements

• Instruct the patient to fast for at least 8 hours prior to the procedure 1
• Provide clear instructions regarding medication management before the procedure, particularly anticoagulants (INR<1.5, Quick >50%, PTT<50s, platelets>50,000/mm³) 1
• Explain that low-dose aspirin may be continued, but other antiplatelet medications may need to be stopped 5 days prior 1

Procedural Details

• Explain that an intravenous line will be placed for administration of sedation 1
• Discuss sedation options and what the patient can expect regarding comfort during the procedure 1
• Inform that the procedure typically takes 15-30 minutes but that they will need additional recovery time 1

Risks and Benefits

• Clearly outline the benefits: accurate diagnosis, potential for therapeutic intervention, and biopsy capabilities 1
• Explain common risks: throat discomfort, bloating, and sedation effects 1
• Discuss rare but serious complications: bleeding, perforation, aspiration, cardiac events, and missed diagnoses 1, 3
• Note that while extremely rare, unusual complications like gastric volvulus have been reported 3

Post-Procedure Information

• Provide instructions for post-procedure care, including when to resume eating and drinking 1
• Explain potential post-procedure symptoms that are normal versus those that would require medical attention 1
• Discuss follow-up arrangements and how results will be communicated 1

Delivery of Information

Timing and Format

• Written information must be provided well in advance of the procedure, not on the day of endoscopy 1
• Verbal information should be provided by an appropriately trained clinician when recommending the procedure 1
• Information should be in plain language that the patient can understand and in an appropriate format/language 1

Special Considerations

• For patients with language barriers, professional interpreters should be utilized to ensure understanding 1
• For inpatients requiring urgent endoscopy, the same principles apply but may need to be expedited 1
• For patients with reduced legal capacity, appropriate consent must be obtained according to local legal requirements 1

Documentation Requirements

• Document that the patient has received and understood the information provided 1
• Ensure written consent is obtained after the patient has had sufficient time to consider the information 1
• Record any specific concerns or questions raised by the patient 1

Common Pitfalls to Avoid

• Avoid providing information only on the day of the procedure, as this does not allow sufficient time for consideration 1
• Don't assume that patients referred by primary care physicians have received adequate information about the procedure 1
• Don't overlook the importance of discussing alternative diagnostic approaches when appropriate 1
• Avoid using medical jargon that may confuse patients 1

Specific Considerations for Epigastric Pain

• Explain that epigastric pain could be due to various conditions and that endoscopy helps distinguish between them 2, 1
• Discuss that functional dyspepsia is a common diagnosis that may be made after excluding structural causes through endoscopy 1
• Note that the presence of alarm symptoms (weight loss, dysphagia, recurrent vomiting, GI bleeding) increases the urgency for endoscopic evaluation 2
• Explain that biopsy samples may be taken to test for H. pylori infection, which is a common cause of gastritis and peptic ulcers 1, 2