1. Colonoscopy

Indications

• Screening or surveillance for colorectal cancer and polyps
• Rectal bleeding, anemia, or positive stool occult blood/FIT test
• Chronic diarrhea or change in bowel habits
• Suspected inflammatory bowel disease
• Biopsy of a lesion
• Removal of polyps, control of bleeding, foreign-body removal

Contraindications / precautions

• Patient in shock until stabilized
• Suspected or known bowel perforation
• Acute severe colitis or toxic megacolon
• Acute diverticulitis
• Severe coagulopathy or thrombocytopenia, particularly when biopsy/polypectomy is planned

Preparation

• Explain procedure and obtain written informed consent.
• Check allergies, medical history, pregnancy status, diabetes medicines, anticoagulants/antiplatelets, and renal disease.
• Low-residue diet followed by clear liquids as ordered.
• Bowel cleansing preparation/laxative as prescribed. A clean bowel is essential for visualization.
• Keep patient NPO according to local sedation policy.
• Baseline vital signs and IV access if sedation is planned.
• Ensure escort is available after sedation.

Procedure

• Usually performed in left lateral position.
• Sedation/analgesia may be given.
• Air or carbon dioxide is introduced to distend the bowel.
• The scope is advanced through rectum to caecum, and the mucosa is inspected during withdrawal.
• Biopsy or polypectomy may be done.

Post-procedure nursing care

• Monitor airway, oxygen saturation, pulse, BP, consciousness, pain, and bleeding.
• Mild bloating, cramps, and flatus are common.
• Do not allow driving, alcohol, machinery use, or important decisions for 24 hours after sedation.
• Encourage fluids and diet as ordered.
• Document procedure, specimen collection, observations, complications, and discharge instructions.

Complications and danger signs

• Bleeding, especially after biopsy or polypectomy
• Perforation
• Sedation-related respiratory depression or hypotension
• Infection is uncommon

2. ERCP

Indications

• Common bile duct stones causing obstruction
• Obstructive jaundice or cholangitis needing biliary drainage
• Benign or malignant biliary stricture
• Bile leak after surgery or trauma
• Pancreatic duct obstruction, stricture, or leak
• Stent insertion or replacement
• Sphincterotomy and stone extraction

Preparation

• Explain procedure and take informed consent, including radiation and complication risk.
• NPO as per policy.
• Check allergies, especially previous contrast reaction, latex, and medications.
• Review anticoagulants/antiplatelets and coagulation profile if sphincterotomy is likely.
• Check CBC, liver function tests, renal function, electrolytes, amylase/lipase if ordered.
• IV access, baseline vital signs, and sedation assessment.
• Remove dentures; maintain safe transfer to fluoroscopy/endoscopy area.
• Give prescribed antibiotic prophylaxis or other medicines.

Procedure

• Usually performed prone, semi-prone, or left lateral position.
• Endoscope is passed to the second part of the duodenum.
• Ampulla of Vater is cannulated.
• Contrast imaging is obtained under X-ray.
• Treatment may include sphincterotomy, stone removal, balloon dilatation, or placement of a biliary/pancreatic stent.

Post-procedure nursing care

• Monitor airway, consciousness, BP, pulse, oxygen saturation, nausea, and pain until recovery from sedation.
• Keep NPO until gag reflex returns, if topical throat anesthesia was used.
• Observe for abdominal pain, fever, bleeding, vomiting, and jaundice.
• Check ordered laboratory tests, especially amylase/lipase if pancreatitis is suspected.
• Document stent placement, specimen collection, medications, observations, and discharge education.

Major complications

• Post-ERCP pancreatitis: most common important complication. Watch for new/worsening epigastric pain radiating to back, vomiting, and raised amylase/lipase.
• Bleeding, especially after sphincterotomy
• Cholangitis or sepsis
• Perforation
• Sedation-related cardiopulmonary complications
• Contrast reaction

3. Endoscopy

Indications

• Dysphagia or odynophagia
• Persistent vomiting, dyspepsia, or upper abdominal pain
• Upper GI bleeding: hematemesis or melena
• Suspected peptic ulcer, gastritis, or malignancy
• Evaluation of varices in portal hypertension
• Biopsy for H. pylori, celiac disease, Barrett esophagus, or suspicious lesion
• Removal of foreign body
• Treatment of bleeding ulcer or esophageal varices
• Dilatation of esophageal stricture

Preparation

• Explain procedure and obtain consent.
• NPO according to policy, commonly at least several hours for solid food.
• Check allergies, dentures, medications, diabetes treatment, anticoagulants, and relevant blood results.
• Establish IV access if sedation or therapeutic intervention is planned.
• Baseline vital signs and oxygen saturation.
• Give local throat anesthetic and/or sedation as prescribed.
• Remove dentures and tight clothing around neck/chest.

Procedure

• Usually performed in left lateral position.
• Mouth guard is placed.
• Scope is passed via mouth through pharynx, esophagus, stomach, and duodenum.
• Air/CO₂ is insufflated for better view.
• Biopsy, hemostasis, variceal banding, dilatation, or foreign-body removal can be performed.

Post-procedure nursing care

• Maintain lateral position until fully awake.
• Monitor airway, respiration, oxygen saturation, pulse, BP, and level of consciousness.
• Keep NPO until gag/swallow reflex returns.
• Mild sore throat, bloating, and belching may occur.
• If sedated, arrange escort and advise no driving or alcohol for 24 hours.
• Check biopsy labels and send specimens promptly.

Complications

• Aspiration
• Hypoxia or respiratory depression from sedation
• Bleeding, especially after biopsy or therapeutic procedure
• Perforation, rare but serious
• Sore throat, nausea, abdominal distension

4. Liver Biopsy

Types

1. Percutaneous liver biopsy
   • Needle inserted through the right upper abdomen/intercostal space, usually ultrasound guided.
2. Transjugular liver biopsy
   • Catheter inserted through internal jugular vein into hepatic vein.
   • Preferred in significant ascites, coagulopathy, thrombocytopenia, or when portal pressure measurement is required.
3. Laparoscopic biopsy
   • Done during laparoscopy or surgery.

Indications

• Diagnose unexplained liver disease or persistently abnormal liver enzymes
• Stage fibrosis in chronic liver disease when indicated
• Assess suspected autoimmune hepatitis, metabolic/infiltrative liver disease, or malignancy
• Confirm or assess steatohepatitis
• Evaluate liver transplant dysfunction, when indicated

Contraindications / precautions

• Uncorrected coagulopathy or severe thrombocytopenia
• Significant ascites for percutaneous route
• Suspected vascular lesion
• Uncooperative patient unable to remain still
• Local infection at puncture site

Pre-procedure nursing care

• Explain procedure and confirm written informed consent.
• Confirm identity, indication, allergies, blood group if required, and fasting status.
• Review coagulation profile, platelet count, hemoglobin, liver and renal function tests.
• Check anticoagulants/antiplatelets are withheld only as prescribed.
• Obtain baseline vital signs.
• Ensure IV access and arrange imaging guidance as ordered.
• Ask patient to empty bladder.
• Position patient as directed, commonly supine with right arm above head for percutaneous biopsy.
• Teach patient to remain still and to hold breath briefly when instructed.

Post-procedure nursing care

• Monitor vital signs frequently according to institutional protocol.
• Observe puncture site/dressing for bleeding.
• Assess abdominal pain, right shoulder pain, distension, pallor, dizziness, tachycardia, hypotension, and respiratory distress.
• Maintain prescribed bed rest and position, often right side lying after percutaneous biopsy depending on local protocol.
• Avoid strenuous activity, heavy lifting, and driving for the period advised by the treating team.
• Give clear discharge instructions and emergency contact advice.

Complications

• Bleeding or hemoperitoneum: most serious complication
• Pain at biopsy site or referred right shoulder pain
• Bile leak/biliary peritonitis
• Pneumothorax, especially with high intercostal approach
• Infection
• Injury to adjacent organs, rare

Quick comparison for viva

Universal nursing responsibilities

• Verify patient identity, consent, indication, allergies, NPO status, and anticoagulant use.
• Record baseline vital signs and ensure safe sedation monitoring.
• Maintain infection-control and specimen-labeling standards.
• Monitor for bleeding, perforation, infection, aspiration, pain, and sedation-related respiratory depression.
• Give clear post-procedure discharge advice and document all care.