Reference — Gastrointestinal
GI Diagnostic Procedures
Quick reference for common GI diagnostic and therapeutic procedures — indications, nursing preparation, post-procedure monitoring, and complication surveillance.
Educational use only. This content is intended for nursing students and exam preparation. Always follow your institution's procedural protocols and provider orders. This material supports nursing education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional policy, or medical direction. Always follow facility protocols and current provider orders.
Direct visualization of the esophagus, stomach, and duodenum using a flexible fiberoptic endoscope passed through the mouth.
Indications
- ✦Upper GI bleed (hematemesis, melena)
- ✦Dysphagia, odynophagia
- ✦GERD refractory to medication
- ✦Suspected peptic ulcer disease
- ✦H. pylori testing and treatment
- ✦Barrett's esophagus surveillance
- ✦Foreign body removal
Complications to Monitor
- !Perforation (<0.1%)
- !Bleeding (especially after biopsy or polypectomy)
- !Aspiration (airway must be protected)
- !Sedation-related respiratory depression
Pre-Procedure Nursing
- ✦NPO 6–8 hours before procedure (solids); 2–4 hours for clears per protocol
- ✦IV access required
- ✦Informed consent
- ✦Remove dentures and eyeglasses
- ✦Document allergies (especially iodine for equipment)
- ✦Hold anticoagulants per provider order
Post-Procedure Nursing
- ✦Monitor airway and gag reflex before allowing oral intake
- ✦NPO until gag reflex returns (typically 1–2 hours after conscious sedation)
- ✦Monitor vital signs per post-procedure protocol
- ✦Assess for signs of perforation: severe chest/abdominal pain, subcutaneous emphysema
- ✦Educate: mild sore throat is normal for 1–2 days
Direct visualization of the entire colon and terminal ileum using a flexible colonoscope inserted via the rectum.
Indications
- ✦Lower GI bleed (hematochezia)
- ✦Colorectal cancer screening (start at age 45)
- ✦Polyp detection and removal
- ✦IBD diagnosis and surveillance
- ✦Iron deficiency anemia workup
- ✦Change in bowel habits
- ✦Chronic diarrhea or constipation workup
Complications to Monitor
- !Bowel perforation (0.1–0.3%)
- !Post-polypectomy bleeding
- !Splenic injury (rare)
- !Electrolyte imbalance from aggressive prep
- !Cardiovascular events from sedation
Pre-Procedure Nursing
- ✦Bowel prep: clear liquid diet day before, split-dose or same-day PEG laxative (Golytely, Miralax) — adherence is critical for adequate visualization
- ✦NPO after midnight for solids (or per protocol)
- ✦IV access
- ✦Informed consent
- ✦Hold metformin and anticoagulants per provider order
- ✦Teach patients: the prep is the hardest part — encourage compliance
Post-Procedure Nursing
- ✦Monitor vital signs and oxygen saturation
- ✦Assess abdomen for distension, pain (expected: mild bloating from air insufflation)
- ✦Educate: mild gas/bloating normal; report severe abdominal pain, fever, or rectal bleeding
- ✦For polypectomy patients: restrict NSAIDs/aspirin, avoid strenuous activity 24–48 hrs
- ✦Document findings and biopsy sites
Endoscopic procedure combining endoscopy and fluoroscopy to visualize the bile ducts and pancreatic duct. Used for both diagnosis and treatment of biliary and pancreatic disorders.
Indications
- ✦Choledocholithiasis (bile duct stones)
- ✦Biliary obstruction (stricture, cholangiocarcinoma)
- ✦Gallstone pancreatitis (stone removal)
- ✦PSC (primary sclerosing cholangitis)
- ✦Sphincterotomy for papillary stenosis
- ✦Biliary stent placement
Complications to Monitor
- !Post-ERCP pancreatitis (3–5%) — most common complication
- !Cholangitis / sepsis
- !Perforation (duodenal or biliary)
- !Bleeding after sphincterotomy
- !Cholecystitis
Pre-Procedure Nursing
- ✦NPO 6–8 hours
- ✦IV access (larger bore — patient at risk for post-ERCP pancreatitis)
- ✦Informed consent with specific discussion of pancreatitis risk
- ✦Fluoroscopy exposure — confirm no pregnancy
- ✦Hold anticoagulants per order
- ✦Prone or left lateral positioning during procedure — ensure patient can tolerate
Post-Procedure Nursing
- ✦Monitor for post-ERCP pancreatitis: epigastric pain radiating to back, elevated amylase/lipase
- ✦Monitor for cholangitis signs: fever, RUQ pain, jaundice (Charcot's triad)
- ✦Monitor bile drainage if stent placed
- ✦NPO until fully recovered from sedation
- ✦Amylase/lipase levels ordered 2–4 hours post-ERCP to screen for pancreatitis
Patient swallows a small wireless camera capsule (approximately pill-sized) that transmits images to a recording device worn by the patient for 8–12 hours as it travels through the GI tract.
Indications
- ✦Obscure GI bleeding (negative EGD and colonoscopy)
- ✦Suspected Crohn's disease involving small bowel
- ✦Small bowel tumor evaluation
- ✦Celiac disease surveillance
- ✦Small bowel polyps (FAP, Peutz-Jeghers)
Complications to Monitor
- !Capsule retention in stricture or Crohn's narrowing (may require surgical/endoscopic retrieval)
- !Aspiration in patients with swallowing dysfunction
- !Battery life limitation — may not visualize entire small bowel if transit time slow
Pre-Procedure Nursing
- ✦NPO 12 hours before capsule ingestion
- ✦Clear liquid diet day before
- ✦Bowel prep may be ordered
- ✦Sensor array applied to abdomen before capsule ingestion
- ✦Educate: capsule naturally excreted in stool (no retrieval required)
- ✦Contraindicated in suspected obstruction, swallowing dysfunction, pacemakers (relative)
Post-Procedure Nursing
- ✦Remove sensor array after 8–12 hours
- ✦Capsule transmission confirmed before removing sensors
- ✦Educate: diet restrictions during recording period (no eating until recording complete)
- ✦Monitor for capsule retention (rare but risk in Crohn's or stricture)
- ✦Images reviewed by gastroenterologist — same-day results not available
Cross-sectional imaging of abdominal and pelvic organs. Can be performed with or without IV contrast, and with or without oral contrast, depending on clinical indication.
Indications
- ✦Acute abdominal pain workup
- ✦Appendicitis, diverticulitis, bowel obstruction
- ✦Abdominal trauma
- ✦Suspected abscess or perforation
- ✦Cancer staging and surveillance
- ✦Active GI bleeding (CT angiography for ≥0.3 mL/min active bleed)
- ✦Pancreatitis severity assessment
Complications to Monitor
- !Contrast-induced nephropathy (CIN) — especially in pre-existing renal disease
- !Anaphylaxis to iodinated contrast (<0.1%)
- !Radiation exposure (use ALARA principles)
- !Delayed contrast reaction (urticaria 1–3 hours post)
Pre-Procedure Nursing
- ✦IV access for contrast administration
- ✦BMP to check creatinine (contrast contraindicated if GFR <30 mL/min or contrast allergy)
- ✦Hold metformin at the time of (not 48 hrs before) contrast if eGFR 30–60 mL/min or intra-arterial contrast; recheck renal function 48 hrs after
- ✦Oral contrast may be ordered (PO vs rectal per indication)
- ✦Pre-medicate with steroids + diphenhydramine for history of contrast allergy
- ✦Pregnancy screen before administration
Post-Procedure Nursing
- ✦Encourage fluids after IV contrast to promote renal clearance
- ✦Monitor for contrast reaction: urticaria, bronchospasm, hypotension, anaphylaxis
- ✦Resume metformin only after renal function confirmed stable 48 hours post-contrast
- ✦Communicate critical findings to provider immediately
Related Resources
Standards & sources
Fact-checked Jun 21, 2026This page is written to align with American College of Gastroenterology (ACG) / AGA · ASPEN (nutrition support). It is an educational summary, not a citation of any single document — always verify specific doses, values, and protocols against current guidelines and your facility policy. How we source content →