UPPER GI ENDOSCOPY
Preprocedure information
Date of the exam:
Fasting for solids:
Name:
Fasting for liquids:
Date of birth:
Premedication:
Indication:
Use of antithrombotic drugs:
No
Yes
Which:
active
interrupted, when?
Periprocedure information
Drugs during endoscopy:
Type of endoscope:
Quality of cleanliness:
Endoscopic findings
Oesophagus
Stomach
Cardia:
Corpus/fundus:
Antrum (including incisura):
Duodenum
Bulb:
Second portion:
Use of virtual chromoendoscopy:
Postprocedure information
Biopsies:
Number of vials:
Duration of the exam:
Complications:
Names of all staff involved and roles:
Recommendations & follow-up
Endoscopist: Dr Sajjad Hussain Chandio – MBBS, FCPS
General & Interventional Gastroenterologist
Electronically generated on:
