SKILLS – Gastroscopy
Sign up “Drop in” gastroscopy outpatient clinic – experience after 9 months Gert Huppertz-Hauss*, Lubomir Chengarov, Stein Dahler, Anita Jrgensen, Volker Moritz, Jrn Paulsen and Geir Hoff * Corresponding author: Gert Huppertz-Hauss Gert.Huppertz-Hauss@sthf.no Department of Gastroenterology, Medical Clinic, Telemark Hospital, 3710 Skien, Norway For all author emails, please log on . For the patient, “drop in” gastroscopy may reduce uncertainty, inadequate therapy and time off work. Methods After an 8-9 month run-in period we asked patients, hospital staff and GPs to fill in a questionnaire to evaluate their experience with “drop in” gastroscopy and gastroscopy by appointment, respectively. The diagnostic gain was evaluated. Results 112 patients had “drop in” gastroscopy and 101 gastroscopy by appointment. The number of “drop in” patients varied between 3 and 12 per day (mean 6.5). Mean time from first GP consultation to gastroscopy was 3.6 weeks in the “drop in” group and 14 weeks in the appointment group. The half-yearly number of outpatient gastroscopies increased from 696 before introducing “drop in” to 1022 after (47% increase) and the proportion of examinations with pathological findings increased from 42% to 58%. Patients and GPs expressed great satisfaction with “drop in”. Hospital staff also acclaimed although it caused more unpredictable working days with no additional staff. Conclusions “Drop in” gastroscopy was introduced without increase in staff. The observed increase in gastroscopies was paralleled by a similar increase in pathological findings without any apparent disadvantages for other groups of patients. This should legitimise “drop in” outpatient gastroscopies, but it requires meticulous observation of possible unwanted effects when implemented. Keywords:
look at this site http://www.biomedcentral.com/1471-230X/12/12/abstract
– Patient is nil by mouth for four to six hours before the procedure. – Patients should be offered the choice of intravenous sedation or local lignocaine throat spray. Sedation is given in incremental doses with time given to assess the effect of the sedation. – The patient is positioned in the left lateral position, head slightly flexed and a mouth guard is inserted. – The equipment is checked. Oxygen is on hand if necessary. – The endoscope is lubricated and inserted into the mouth guard, over the tongue to the oropharynx. The patient is asked to swallow to assist the advancement of the endoscope. – The endoscope is passed down the oesophagus, through the lower oesophageal sphincter and into the stomach. Water may be passed down the endoscope to act as a wash and improve views. Air may be insufflated within the stomach, to aid views.
Rood & Riddle to Host Merial Gastroscopy Event
Steve Reed along with Merial veterinarian Hoyt Cheramie, DVM, DACVS, will be on hand to perform gastroscopy exams and provide educational commentary to explain the procedure, exam results, and educational information on the diagnosis, treatment and prevention of gastric ulcers. Owners purchasing GastroGard at the event will receive a $5 per tube Rebate Coupon for every tube purchased up to 28 tubes. Standard treatment protocol for horses diagnosed with gastric ulcers is to administer GastroGard orally once daily for 28 days at the rate of one tube per 1,250lbs of body weight. Individual dosage and treatment recommendations are based on the horse’s body weight and severity of ulcer. Gastric ulcers are a common medical condition in horses and foals. Numerous publications have identified that up to 60% of show horses have ulcers and up to 90% of racehorses may develop gastric ulcers. There are many triggers for stomach ulcer development, and stress is an important factor. Horses may experience stress when exposed to situations that you might think of as normal routine such as training, travel, competition, shows or events, or changes in routine such as lay-up due to sickness or injury. Clinical signs associated with gastric ulcers are numerous and often vague. Typical symptoms include poor performance, poor hair coat, picky eating, and colic. Oftentimes diagnosis of gastric ulcers can be tricky because the signs can be subtle and easy to misinterpret. The gold standard of diagnosis is gastroscopy, which is visualization of the stomach with a 3 meter endoscope. The primary goal of treatment is suppression of gastric acid which creates an environment conducive for healing. The most commonly used product is omeprazole, which is available under the brand name GastroGard, the only FDA approved treatment. GastroGard is a paste given orally once a day for 28 days and gastric ulcers heal well. Omeprazole is also available in a lower dose product, UlcerGard, for use as a preventative against recurrence in horses with a history of ulcers, or for use during times of stress. Merial has conducted more than 160 gastroscopy events nationwide with 60% of horses diagnosed with stomach ulcers. Throughout the year, 1,532 horses across the country participated in events. Overall, 922 horses from 37 states had some ulceration as identified by gastroscopy. Horses of varying ages and disciplines were found to have all grades of stomach ulcers, including: Horses from 2 months to 30 years of age 610 horses, or 40 percent, were Grade 0 (healthy, non-ulcerated stomach) 471 horses, or 31 percent, were Grade 1 (mild ulcers, with small lesions or damaged tissue) 319, or 21 percent, were Grade 2 (moderate ulcers with large lesions) 132, or 9 percent, were Grade 3 (extensive lesions with deep ulceration and bleeding) 86 percent of racing horses had some grade of ulcers (226 total participating) 59 percent of eventing horses (113 total participating) 59 percent of hunter jumpers (168 total participating) 52 percent of barrel racing horses (122 total participating) 48 percent of dressage (107 total participating) Owners with horses that travel, compete, train or experience potentially stressful situations regularly, are invited to participate in this gastroscopy event. The gastroscopy exams are by appointment which can be scheduled with Whitney Mathes at 859-233-0371 or by e-mail to wmathes@roodandriddle.com . Anyone interested in learning more about gastric ulcers in horses is welcome to attend the seminar at any time during the day, a horse is not required.
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