Endoscopy

Outline

• Equipment• Accessories

Endoscopy

• Fiberoptic endoscopy 1961=flexible, “one eye at a time at the ocular”

• Video endoscopy- miniature CCD (charge-coupled devices) –mid 1980s, fiber optics provide the light, CCD digitizes and transmits to processor

Upper Endoscopy

• Rate of complications 0.11% Shamir M Schuman BM Gastrointest Endosc 1980;26:86-91

• Most common is respiratory depression• Most serious is perforation (0.03%)-site is

usually the piriform fossa

Enteroscopy

• Thread-guided method-thread/teflontube/scope (no longer available)

• Push –most commonly used, +/- overtube• Sonde-piggy-back• Intraoperative• Wireless capsule

Colonoscopy

• Complications-usually related to therapy• Hemorrhage -1-2% of polypectomy, 2 weeks• Perforation –less frequent (0.5-1% of

polypectomy)• Polypectomy syndrome- pain, fever,

leukocytosis due to peritonitis from full thickness burn

• Pneumatic perforation-R colon, remove air on withdrawal

Gastroscope-GIF 160

• ED 8.6 mm (accomodates bander 8.6-11.5 mm)

• Channel 2.8 mm – standard size• Bx/snare-2.8 mm, Roth net 2.5• Injector/heater probe 2.3 mm

GIF- N180

• ED 4.9, channel 2 mm

• Trans-nasal, without sedation

Colonoscopes

• Peds colonoscope• Same length as adult• 11.3 mm/3.2 mm• Newer adult scope is 12.8/3.7-older adult

scopes have larger diameters

Hemostasis

• Non-varicealInjection-epi (1:10000),

sclerosants, fibrin sealant

Contact thermal device-heater probe

Noncontact: Nd:YAG, APC

Clips

Thermal Devices-Contact

• Heater probe, multipolar probe

• More effective at coagulating medium-sized arteries

• Coaptivecoagulation= tamponade+coagulation and wash

Contact Thermal Devices

• Bipolar coagulation (BICAP or gold probe)

10-20 W, 2-10 s (adult)• Heater probe10-30 J, 2-4 pulses

Polypectomy bleeding

Thermal Devices-noncontact

• Nd:YAG laser• Argon plasma

coagulation

Variceal hemorrhage

• Injection sclerotherapy- risk of complication outweigh its use for primary prophylaxis

• Bleeding, ulceration, bacteremia, pleural effusion, perforation

• Banding-preferable to injection particularly in prophylaxis

• Cyanoacrylate glue-gastric varices

Variceal banding

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