5 Endoscopic and Pulmonary Procedures

Purpose and safe preparation

Endoscopic procedures let clinicians inspect the gastrointestinal tract or airways and, when indicated, collect tissue or fluid samples or provide treatment. Safe care depends on procedure-specific preparation, appropriate sedation and airway monitoring, and recognition of complications.

Preparation and patient teaching

Before the procedure, verify the patient’s identity, planned procedure, consent, allergies, relevant medical history, and baseline status. Ask about prior problems with sedation, sleep apnea or other airway concerns, heart or lung disease, current medicines—including anticoagulants, antiplatelets, and diabetes medicines—and the time and contents of the last food or drink. Assess airway and cardiopulmonary risks when sedation is planned.

Fasting and medication instructions vary. Clarify medication changes with the procedural team; patients should not independently stop prescribed medicines.

Procedure-specific preparation

• Upper endoscopy (EGD): An empty stomach supports a clear examination and reduces aspiration risk. Give the exact fasting instructions supplied by the care team; do not assume one fasting interval applies to every patient or procedure.

• Colonoscopy: Explain and confirm the prescribed diet and bowel-cleansing regimen, which is often taken in split doses. Encourage prescribed fluids to reduce dehydration risk while following any fluid restrictions. Inadequate preparation can obscure lesions and may require rescheduling; a negative examination may not be reliable if the colon was not adequately cleaned. The team should provide individualized medication and transportation instructions.

• Bronchoscopy: Follow the instructed fasting and medication plan. Tell the team about blood-thinning medicines, allergies, and relevant health conditions, and do not stop medicines without direction.

If sedation is planned, arrange an escort and follow discharge instructions about supervision and activity. After sedated upper endoscopy, ASGE patient guidance advises avoiding driving, operating machinery, and making legal decisions for the remainder of the procedure day.

Sedation and airway monitoring

Sedation can reduce alertness and protective airway reflexes. Before and during sedated GI endoscopy, assess the patient and monitor vital signs, oxygen saturation, level of consciousness, and breathing. Pulse oximetry alone does not measure ventilation. Deeper sedation or higher-risk patients may require additional monitoring and airway expertise, and trained personnel and appropriate rescue equipment should be available.

Continue monitoring after the procedure until the patient meets the unit’s recovery and discharge criteria. Watch for excessive sedation, slow or obstructed breathing, falling oxygen saturation, aspiration, and hemodynamic instability. If a patient becomes difficult to arouse and oxygen saturation falls, promptly assess breathing and airway, alert the procedural team, and initiate the unit’s rescue response.

Recovery and aftercare

After bronchoscopy with throat-numbing medication, withhold food and drink until the gag and cough reflexes have returned. Swallowing while the throat is numb can cause choking. Then restart with small sips as directed.

Mild, short-lived symptoms may include a sore throat or bloating after EGD and a scratchy throat or cough after bronchoscopy. After sedation, follow the facility’s instructions for activity, supervision, and resuming medicines. Biopsy and polyp-removal results may take several days; an immediate visual impression is not the same as a final pathology result.

Complications and warning signs

Teach patients to contact the care team promptly about warning signs. Severe breathing difficulty, heavy bleeding, or collapse requires emergency assessment.

• EGD: Complications include sedation-related cardiopulmonary events, bleeding—especially after biopsy or treatment—and rare perforation. Trouble breathing or swallowing, fever, worsening chest or abdominal pain, vomiting blood, or black stools need prompt clinical assessment.

• Colonoscopy: Complications include sedation-related events, bleeding—particularly after polyp removal—and rare perforation. Severe or worsening abdominal pain, fever, substantial rectal bleeding, dizziness, or fainting need prompt assessment.

• Bronchoscopy: Temporary cough or minor blood-streaked sputum may occur. Important risks include airway bleeding, infection, and pneumothorax, especially after lung biopsy. Increasing shortness of breath, chest pain, significant or increasing blood in sputum, or persistent fever need prompt assessment.

Findings and interpretation

Findings seen during an examination may guide further testing, but appearance alone does not always establish a diagnosis. Interpret findings alongside biopsy results and other relevant clinical information.

• EGD: The clinician may see inflammation, such as esophagitis or gastritis; ulcers; narrowing; or enlarged esophageal veins (varices). Biopsies can investigate causes such as Helicobacter pylori or evaluate abnormal tissue. A visual finding, such as a gastric ulcer, does not alone confirm its cause; biopsy results may clarify the diagnosis and may not be available immediately.

• Colonoscopy: The clinician may see polyps, diverticula, inflammation, or a mass. A polyp may be removed and sent for pathology, which helps determine what it is and what follow-up is appropriate. Poor cleansing limits visualization, so a negative examination after inadequate preparation may not be reliable.

• Bronchoscopy: The clinician may observe airway inflammation, secretions, bleeding, narrowing, or a visible lesion. Bronchoalveolar lavage (BAL), brushing, or biopsy can collect samples to investigate infection, inflammation, or cancer. Interpret a sample result with the clinical picture and imaging; an abnormal finding alone is not a final diagnosis.