If you have severe cardiopulmonary disease, blood disorders, coagulation disorders, and are taking anticoagulants, endoscopic resection is strictly contraindicated until coagulation is corrected.
The surgeon will perform a comprehensive evaluation of your systemic condition in the preoperative preparation phase, correcting abnormal coagulation and providing a series of consultations and management for those with underlying medical conditions before proceeding with treatment.
I. Patients with underlying conditions such as hypertension, diabetes, and coronary artery disease
Endoscopic surgery requires intravenous or general anesthesia, and if you have some combination of underlying conditions, such as hypertension, coronary artery disease, or diabetes, you need to be evaluated for anesthesia and have the underlying conditions controlled with medications or other treatments to minimize the risk of anesthesia before you can undergo endoscopic surgery.
The appropriate solution for each underlying disease:
Patients with hypertension
- There is generally no need to discontinue antihypertensive medication before endoscopy, and it is important to try to control blood pressure at a satisfactory level.
- You need to know what antihypertensive medication you are taking and communicate with your surgeon and anesthesiologist promptly.
- When oral medications must be discontinued, other routes of blood pressure control need to be considered, often including: parenteral medications such as diuretics, adrenal inhibitors, vasodilators; sublingual nifedipine; and colistin absorbed through the skin. All of these methods can prevent the rebound of hypertension caused by sudden discontinuation of medication.
- Resume antihypertensive medication promptly after surgery as prescribed by the doctor. If you cannot take them orally, consult your primary care physician or cardiology to control your blood pressure by other means.
Patients with diabetes
- You need to tell your doctor which glucose-lowering medications you are taking, and their use and dosage;
- The usual blood glucose control;
- Whether you have any complications of diabetes, such as diabetic foot, diabetic retinopathy, etc;
Patients with coronary artery disease
Your heart must be evaluated before the procedure. The relevant tests include: cardiac ultrasound, ambulatory electrocardiogram, coronary CT, coronary angiography, etc., as a way to see if you are physically fit for the procedure.
II. Patients with compromised coagulation
- Patients with coronary artery disease and other conditions often take oral medications that affect coagulation, such as aspirin. Because of the bleeding risks associated with endoscopic procedures, if you have been taking oral anticoagulants or antiplatelet medications for a long time, you will need to stop taking them for 5 to 7 days before undergoing the endoscopic procedure, if appropriate. If you are unsure, it is recommended that you consult your primary care physician. Patients who are unable to discontinue anticoagulants may be able to substitute anticoagulant therapy with medications that have a low impact on bleeding risk, such as low-molecular heparin, under the guidance of a specialist.
- Patients with abnormal coagulation require correction of coagulation before endoscopic resection therapy.
- For female patients with abnormal coagulation, treatment should avoid the physiological period.
In general, the relevant indicators should be controlled: hemoglobin should not be less than 50 g/L or prothrombin time (PT) should not be prolonged by more than 1.5 seconds. It is still up to your primary care physician to determine the exact numbers.
III. Patients with colds and fever
Postoperative temperature, which is an important indicator of the presence of late perforation complications. To avoid other factors, if you have a preoperative cold and fever, you need to be treated until your temperature is normal and the infection is controlled before undergoing endoscopic surgery.
To summarize, if you have underlying medical conditions such as high blood pressure, diabetes, heart disease, or a cold and fever, you need to be seen in the relevant department in a timely manner and listen to the advice of a medical professional to get your underlying medical conditions under control. As long as the control is reasonable and the preoperative physician has done an adequate evaluation, the majority of patients can undergo endoscopic treatment without any problems.
Co-written by:
Dr. Wang Police, Endoscopy Center, Peking University Cancer Hospital