Endoscopy is a minimally invasive procedure that uses a flexible tube with a camera and light source (endoscope) to examine the interior of the gastrointestinal (GI) tract. Endoscopy can be used for both diagnostic and therapeutic purposes in critically ill patients with GI bleeding, perforation, obstruction, or infection. The diagnostic value of endoscopy depends on the timing, location, and cause of the GI problem. Endoscopy can help to identify the source and severity of bleeding, the presence and type of ulcers, erosions, varices, tumors, or foreign bodies, and the signs of inflammation, infection, or ischemia. The therapeutic value of endoscopy depends on the availability, feasibility, and efficacy of endoscopic interventions. Endoscopy can help to stop bleeding, remove foreign bodies, dilate strictures, place stents, biopsy lesions, or administer drugs or fluids.
The association of endoscopy with outcomes in critical care medicine is not well established. Some studies have suggested that early endoscopy (within 24 hours) may reduce mortality, rebleeding, transfusion, and surgery rates in patients with acute upper GI bleeding. Other studies have suggested that endoscopy may improve survival, symptom relief, and quality of life in patients with malignant GI obstruction or perforation. However, more evidence is needed to confirm these findings and to determine the optimal timing, indications, and techniques of endoscopy in different clinical scenarios.
References:
Stanley A J, Laine L. Management of acute upper gastrointestinal bleeding BMJ 2019; 364 :l536 doi:10.1136/bmj.l536