Synopsis
Select upper endoscopy, colonoscopy, targeted biopsy or capsule examination for the clinical question; prepare and consent the patient safely; and recognise bleeding, perforation, sedation injury and capsule retention promptly.
- Choose the test by the suspected anatomical site and whether tissue or therapy is needed: capsule endoscopy visualises but cannot biopsy, insufflate, wash or treat.
- Urgent endoscopy follows stabilisation in major gastrointestinal bleeding, obstruction or foreign-body emergencies; airway, circulation and senior support come first.
- Consent must be procedure- and patient-specific, including alternatives, sedation choices, likely biopsy or therapy and material risks such as bleeding, perforation, aspiration and missed lesions.
- Anticoagulant and antiplatelet management depends on both procedural bleeding risk and the patient's thrombotic risk; never advise interruption from a generic rule.
- Adequate fasting, bowel preparation and mucosal inspection determine diagnostic quality. An incomplete or poorly prepared test is not simply 'normal'.
- Biopsy site, number, orientation and container labelling matter; normal-looking mucosa may still require tissue in coeliac disease, microscopic colitis or eosinophilic disease.
- Before capsule endoscopy, assess obstruction or stricture risk and use cross-sectional imaging or a patency capsule when indicated; retention can require device-assisted or surgical retrieval.
- Post-procedure severe pain, tachycardia, fever, dyspnoea, haematemesis, melaena or peritonism requires urgent assessment for perforation, bleeding, aspiration or pancreatitis.
Key red flags
Ongoing haematemesis, melaena with shock, variceal bleeding, obstructing food bolus with inability to handle secretions or a dangerous foreign body needs urgent specialist endoscopy after immediate stabilisation.
Severe or increasing chest or abdominal pain, tachycardia, fever, subcutaneous emphysema, dyspnoea or peritonism after endoscopy requires urgent imaging, nil by mouth and senior surgical and endoscopy review.
Haematemesis, melaena, haematochezia, dizziness, falling haemoglobin or instability after biopsy, sphincterotomy or polypectomy needs resuscitation and a procedure-specific haemostasis pathway.
Hypoventilation, hypoxia, hypotension, arrhythmia, reduced consciousness or aspiration can occur during and after the procedure, especially with frailty, OSA, liver or renal disease and combined sedatives.
Investigation priorities
Inspect and treat oesophageal, gastric and duodenal disease in dysphagia, upper bleeding, mucosal disease, selected anaemia and surveillance indications.
Management branches
A gastrointestinal symptom or abnormal test warrants luminal investigation.
- Define the anatomical hypothesis, urgency and need for tissue or therapy, and review prior endoscopy and imaging quality.
- Select OGD, colonoscopy, flexible sigmoidoscopy, enteroscopy, capsule or a non-endoscopic alternative with the gastroenterology pathway.
- For capsule, assess stricture and swallowing risk and use enterography or patency testing when indicated.
- State how each possible result will change management and identify who owns histology or delayed capsule reporting.