Thanks for the D2D. When I find an abnormality, I will do the following:
- Make an endoscopic diagnosis. In many conditions, a good endoscopic diagnosis and picture documentation is sufficient to proceed to management.
- Try to find an underlying cause of the condition. For example, if there is a stomach ulcer, I will look for an underlying infection which may have caused the ulcer.
- Assess the severity of the condition and look for associated complications.
- Determine whether tissue biopsy is needed, and obtain the appropriate samples if so.
Even if no abnormality is found, I may still obtain tissue biopsies to look for abnormalities at the microscopic level. Some disorders have a normal endoscopic appearance, and can only be diagnosed through a biopsy.
I will assess the possibility of such conditions based on the patient’s symptoms and risk factors, and will plan the biopsies accordingly.
If I detect something that can be treated endoscopically, I may proceed to treatment immediately. This includes abnormalities which are bleeding or have high risk of bleeding, and growths that are simple to remove.
If the endoscopic treatment is more complex, I will usually defer it to another day. This will allow me to discuss the findings with the patient, to explain endoscopic treatment and the alternatives, and to advise on the increased risk and cost of the treatment.
