I. Standard inpatient procedure of endoscopic gastric polypectomy clinical pathway
(A) Applicable objects
The first diagnosis of gastric polyp (ICD-10: K31.7/D13.1).
Endoscopic gastric polypectomy (ICD-9-CM-3: 43.4102).
(II) Diagnostic basis
According to “Practical Internal Medicine”, “Gastrointestinal Endoscopy” and other domestic and foreign clinical and endoscopic diagnosis and treatment guidelines.
1.Gastric polyps were found by gastroscopy.
2.Filling defect was found by barium meal angiography, suggesting gastric polyp.
(C) The choice of treatment plan
According to “Practical Internal Medicine”, “Gastrointestinal Endoscopy” and other domestic and foreign clinical and endoscopic diagnosis and treatment guidelines.
1.Basic internal medicine treatment (including lifestyle, diet, etc.)
2.Endoscopic treatment.
(D) Standard hospitalization days are 5C7 days
(V) Criteria for entering the clinical pathway
1.The first diagnosis must conform to ICD-10: K31.7/D13.1 gastric polyp disease code.
2.Meet the indications for endoscopic resection of gastric polyps.
3.When the patient has other disease diagnosis at the same time, but no special treatment is needed during hospitalization, and it does not affect the implementation of the clinical pathway process of the first diagnosis, it can be entered into the pathway.
(F) Examination items during hospitalization
1.Required examination items.
(1) Routine blood, blood type and Rh factor.
(2) Routine urine.
(3) Routine stool + occult blood.
(4) Liver and kidney function, electrolytes, blood glucose.
(5) Infection index screening (hepatitis B, C virus, HIV, syphilis).
(6) Coagulation function.
(7) electrocardiogram, abdominal ultrasound, chest X-ray.
2.Checkup items that can be selected according to the patient’s condition.
(1) Gastrointestinal tumor index screening (CA199, CA242, CEA, etc.)
(2) Ultrasound endoscopy.
(3) Colonoscopy.
(vii) Endoscopic treatment for the 3rd day after hospitalization
1.Pre-operative completion of gastroscopy and consent for treatment.
2.Sedative or anesthetic drugs may be used: intraoperative monitoring of vital signs is required, and postoperative observation in the endoscopy room until awake and return to the ward.
3.Regular gastroscopy is performed in order.
4.Decide the endoscopic treatment plan according to the polyp morphology, size and number seen intraoperatively and implement the treatment according to the endoscopic treatment norms for gastric polyps, and use appropriate measures to avoid possible treatment complications during the perioperative period.
5.Anti-platelet drugs should be stopped for 5 days or more.
6.Recover the resected specimen for pathological examination if possible.
7.Postoperative close observation of the condition, timely detection and management of possible complications.
(H) Selection of medication
1.Use acid suppressants (such as PPI/H2RA).
2.Use mucosal protective agents.
3.Antibiotics if necessary.
(ix) Discharge criteria
1.No bleeding, perforation, infection and other complications.
2.The general condition of the patient allows.
(J) Variation and cause analysis
1.Patients younger than 18 years old, or older than 65 years old, enter the clinical pathway for special populations.
2.Patients with contraindications to gastroscopic operation enter the clinical pathway for special populations: such as dysfunction of important organs such as heart and lungs and coagulation dysfunction, those with mental disorders who cannot cooperate, the acute phase of upper gastrointestinal perforation or the perioperative phase of gastrointestinal surgery, severe pharyngeal disorders where the endoscope cannot be inserted, the acute phase of corrosive esophageal injury, etc.
3, those who apply drugs affecting platelet and coagulation function, enter the clinical pathway for special populations.
4, polyps do not meet the indications of endoscopic treatment, or patients with contraindications to endoscopic treatment, discharged or transferred to surgery, into the clinical pathway of gastric tumor surgical treatment.
5.Combined with acute gastrointestinal hemorrhage, enter the clinical pathway of gastrointestinal hemorrhage, perform endoscopic hemostasis, and transfer to surgery if necessary.
6.Combined infection, need to continue anti-infection treatment, enter the clinical pathway of gastrointestinal tract infection.
7, combined with gastrointestinal perforation, turn to surgery, enter the corresponding clinical pathway.
8.Pathology suggesting malignancy, turn to surgery and enter other pathways.
9.Multiple polyps, large polyps or complex cases: multiple >3, or polyps ≥2cm in diameter or broad-based polyps or thick-tipped polyps (tip diameter ≥1cm).