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How to Become a Family Nurse Practitioner

Image by CDC on Unsplash If you are a registered nurse, becoming a family nurse practitioner (FNP) can be an excellent way to advance your career and make a deeper impact on patients’ lives across all age groups. As an FNP, you can diagnose conditions, prescribe medications, and provide comprehensive care in different settings, including clinics, hospitals, and private practices. Let’s explore four tips to help…

Essential Skills Every Endoscopy Nurse Should Master

Photo courtesy of Freepik Endoscopy nursing is a combination of technical skills, patient care, and quick thinking. Whether you’re helping with a colonoscopy, titrating sedation for an upper GI procedure, or soothing an anxious patient, the job involves a special skill set that’s not in the textbook.  For nurses, acquiring these skills is about building a foundation to allow you to excel in high-stress environments where…

5 Things to Consider When Choosing a Nurse Practitioner Program

Photo courtesy of Unsplash Choosing the right Nurse Practitioner program is an important step toward advancing your nursing career and expanding your scope of practice. With the growing demand for skilled healthcare providers, these programs have become increasingly diverse. They offer a wide range of specializations and formats. However, not all programs are created equal; so, finding one that matches your goals, lifestyle, and professional aspirations…

How to Succeed in an Online DNP Program Without Sacrificing Your Current Job

Photo by MedicAlert UK on Unsplash Balancing a demanding nursing career while pursuing advanced education can seem daunting. However, online Doctor of Nursing Practice (DNP) programs have revolutionized accessibility for working professionals. With strategic planning and the right support, you can excel academically while maintaining your professional responsibilities. This blog provides practical strategies to help you navigate this challenging but rewarding journey. Understanding the Flexibility of…

Do Medical Bills Affect your Credit

Current Impact on Credit Scores Medical bills don’t affect your credit score if paid on time. But if left unpaid and sent to collections, they can affect your score, though recent changes have reduced the risk. As of now, medical collections under $500, paid collections and collections less than a year old are not reported on credit reports. So only large, older unpaid medical debts will…

Sedation and Monitoring in Endoscopy

Introduction Sedation is regularly used to facilitate the performance of endoscopic procedures. Sedation practices have noticeably changed over the past decade, with a shift from no or moderate sedation to monitored anesthesia care (MAC) for gastrointestinal (GI) endoscopy. Sedation during an endoscopic procedure helps in two ways; first, by decreasing procedural pain, thereby making the patient more comfortable, and second, by decreasing any untimely patient movements,…

Electrosurgery in Therapeutic Endoscopy

Introduction The therapeutic basis of all electrosurgery is the use of high frequency, alternating electric current to produce heating in living cells. The heating can be manipulated to achieve a desired tissue effect such as cutting, tissue ablation, desiccation, or a combination of these. Electrical energy to produce heating and tissue effects has been a part of endoscopy since the early 1970s. Common indications include biliary…

Tissue Sampling, Specimen Handling, and Laboratory Processing

Endoscopic Biopsy Biopsy Techniques Pinch Biopsy Forceps The most common pinch biopsy forceps used worldwide fits through a 2.8-mm biopsy channel ( Fig. 5.1 ). In general, mucosal samples vary from 4 to 8 mm in size. A smaller-sized forcep that fits through a 2.2 mm biopsy channel is used in infants and young children. Pediatric gastroenterologists generally use narrow-bore instruments for routine diagnostic biopsies if the child…

Cleaning and Disinfecting Gastrointestinal Endoscopy Equipment

Introduction The field of gastrointestinal (GI) endoscopy has expanded dramatically as new procedures, instruments, and accessories have been introduced into the medical community; more than 20 million GI endoscopies are performed annually in the United States. Although GI endoscopes are used as a diagnostic and therapeutic tool for a broad spectrum of GI disorders, more health care–associated infectious outbreaks and patient exposures have been linked to…

How Endoscopes Work

Endoscopes are flexible instruments combining fiber-optics (for illumination) and charge-coupled devices (for imaging) that are used in medicine to visualize the interior of otherwise inaccessible sites, such as the lumen of hollow organs. Endoscopes are used to examine the gastrointestinal (GI) tract, the bronchial system, the ureters and other body cavities. They have numerous uses in non-medical settings as well and are central to the modern…

Setting Up an Endoscopy Facility

Introduction The safe and efficient performance of gastrointestinal (GI) endoscopy has the following requirements: A properly trained endoscopist with appropriate privileges to perform specific GI endoscopic procedures Properly trained nursing and ancillary personnel Operational, well-maintained equipment Adequately designed and equipped space for patient preparation, performance of procedures, and patient recovery Cleaning areas for reprocessing endoscopes and accessories Trained personnel and appropriate equipment to perform cardiopulmonary resuscitation…

The History of Gastrointestinal Endoscopy

Introduction The role of the physician is to observe, detect anatomic abnormalities or disease, and conceive ways and means by which discovered deficiencies in function can be corrected or ameliorated. To extend the physical examination to areas hidden from external view, such as within body orifices, presents a problem of safe and effective access. In insatiable attempts to accomplish these goals, there is no human orifice…

Posttreatment Surveillance, Risk for Recurrence of Barrett’s Esophagus, and Adenocarcinoma After Treatment

15.1 Introduction Endoscopic eradication therapy (EET), either using endoscopic resection (ER) or radiofrequency ablation (RFA), cryoablation, or a combination of resection and ablation, aims not only to completely eliminate Barrett’s esophagus (BE) dysplasia and early neoplasia but also a complete eradication of intestinal metaplasia (CEIM) . EET is mostly applied in patients with high-grade dysplasia (HGD) and intramucosal cancer (IMC) and increasingly in patients with BE…

Chemoprevention of Barrett’s Esophagus and Adenocarcinoma

14.1 Introduction Barrett’s esophagus (BE) is an acquired condition in which a metaplastic columnar epithelium replaces the stratified squamous epithelium that normally lines the distal esophagus . Metaplasia commonly is a consequence of chronic inflammation, and intestinal metaplasia results from chronic reflux esophagitis caused by the gastroesophageal reflux of acid, bile, and other hazardous substances . Approximately 5% of adult population in the United States is…

Endoscopic Surgical Therapies for Barrett’s Esophagus

13.1 Introduction Earlier chapters in this book describe how ablative therapies have essentially replaced surgery for the management of Barrett’s esophagus (BE) with high-grade dysplasia (HGD). However, resectional therapies, performed either with flexible endoscopy or surgery, are still required for managing this disease either as an adjunct to ablation or for definitive therapy. This chapter describes the indications for using resectional therapies in the management of…

Cryospray Ablation

12.1 Introduction Endoscopic cryospray ablation or cryotherapy is a unique method of ablation that offers physicians a versatile choice in the treatment of Barrett’s and early esophageal cancer. The concept of endoscopic cryospray ablation began in the late 1990s with the development of two delivery platforms using liquid nitrogen (LN) and carbon dioxide (CO 2 ). Both methods share some unique characteristics compared to other ablation…

Radiofrequency Ablation

11.1 Introduction Barrett’s esophagus (BE) occurs when an abnormal, intestinal-type epithelium called “specialized intestinal metaplasia” replaces the stratified squamous epithelium that normally lines the distal esophagus. The condition develops as a consequence of chronic gastroesophageal reflux disease and predisposes to the development of adenocarcinoma of the esophagus . Traditionally, high-grade dysplasia (HGD) and intramucosal carcinoma (IMC) arising from BE were treated with esophagectomy, while nondysplastic BE…

History of Ablative Therapies for Barrett’s and Superficial Adenocarcinoma

10.1 Introduction A general outline of this chapter includes a brief background followed by historical trends of endoscopic ablation (with the exception of radiofrequency ablation and cryospray ablation, which are covered in chapter 11, chapter 12 : Radiofrequency Ablation and Cryospray Ablation) for nondysplastic Barrett’s esophagus (BE), BE with low-grade dysplasia (LGD), and BE with high-grade dysplasia (HGD)/intramucosal esophageal adenocarcinoma (EA). Finally, therapeutic options for endoscopic…

Enhanced Imaging of the Esophagus: Confocal Laser Endomicroscopy

9.1 Introduction Barrett’s esophagus (BE) is associated with the risk of development of esophageal adenocarcinoma. Current surveillance according to the Seattle protocol includes white light endoscopy (WLE) with the collection of random four-quadrant biopsy specimens over every 1–2 cm of the columnar-lined esophagus. The aim of such surveillance is detection of neoplasia, ideally at an (endoscopically) curable stage. This state-of-the-art approach is labor intensive and prone…

Enhanced Imaging of the Esophagus: Optical Coherence Tomography

8.1 Introduction Optical coherence tomography (OCT) is an optical analog of ultrasound imaging that was invented in the early 1990s . OCT fills a resolution gap between confocal laser endomicroscopy (CLE) and ultrasound, affording the capability of visualizing architectural microscopic morphology at a resolution of approximately 10 µm and to a depth of several millimeters (mm). OCT is also advantageous in that it provides cross-sectional images…