For your information... OGD and dilatation

Oesophago-gastroduodenoscopy is a safe procedure that allows direct visualisation of the upper part of the gastrointestinal tract up to the duodenum.

Indications:
Diagnostic

• Investigation for anaemia
• Upper GI bleeding
• Persistent Dyspepsia
• Persistent vomiting
• Dysphagia
• Odynophagia

Surveillance

• Surveillance of already diagnosed Barrett's oesophagus
• Previous gastric/duodenal ulcers

Therapeutic

• Oesophageal varices
• Banding
• Sclerotherapy
• Epinephrine injections into actively bleeding lesions
• Insertion of Sengstaken-Blackmore's tube
• Polyps
• Removal of FBs
• Oesophageal stenosis
• Dilatation
• Stenting
• Insertion of PEG tube
• ERCP

Safety

Most common complication is Sorethroat

Complication rate is 1 in 1000

• Aspiration
• Bleeding
• Perforation

Risk of dilatation

• Review of 1862 endoscopic dilatations using Savary-Guillard technique showed complication rate of 0.18% for benign strictures and 4.58% for malignant aetiologies (Piotet E, Eur Arch Otorhinolaryngol.  2008 Mar)
• Certain strictures refractory to treatment and require multiple dilatations
• E.g. caustic, post-surgical, post radiotherapy strictures.

For you information... Haemostasis

This question is taken from the London Feb 2013 exam.

Question:
What are the stages of haemostasis?

Answer:
Haemostasis is a process that causes bleeding to stop. There are 3 steps that occur in rapid sequence.

1. Vasoconstriction (vascular spasm): The damaged blood vessels contract as the first response to injury. This reduces blood flow to the area and limits the amount of blood loss. It is triggered by local pain receptors as well as local chemicals released by the damaged endothelial cells.
2. Platelet plug formation: Platelets adhere to the damaged endothelium to for a platelet plug and seals up the break in the vessel wall. They then release chemical mediators such as adenosine diphosphate (ADP), serotonin and thromboxane A2 that potentiate more platelets to adhere to the platelet plug.
3. Activation of the coagulation pathway: The platelet plug is reinforced by activation of the coagulation pathway and the subsequent products. Fibrinogen is converted to fibrin by thrombin. Clot regulation occurs through a negative feedback loop to prevent excessive clotting.