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.
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.
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.
Key medicines
MidazolamTitrate small intravenous increments to the minimum effective conscious-sedation level under the BSG and local endoscopy protocol; use substantially less in frail, older or comorbid adults.
FentanylUse small titrated intravenous doses only within the local endoscopy-sedation protocol, accounting for age, frailty, opioid exposure and concurrent benzodiazepine.