Principles and Practice of GI Endoscopy
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A SEMINAR ON A SEMINAR ON PRINCIPLES AND PRINCIPLES AND PRACTICE OF GI PRACTICE OF GI ENDOSCOPYENDOSCOPY
Guide; Dr. M.Singh (M.S.)Guide; Dr. M.Singh (M.S.) Associate professorAssociate professor Dept of SurgeryDept of Surgery
Presented byPresented by Dr.K.RaviDr.K.Ravi
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History of EndoscopyHistory of Endoscopy
Kussmaul in 1869 introduced silver tube successfully Kussmaul in 1869 introduced silver tube successfully into the stomach of the sword-swallower and became into the stomach of the sword-swallower and became the first person in medical history to visualize the the first person in medical history to visualize the stomach. stomach.
In 1957 first prototype fiber optic endoscope was In 1957 first prototype fiber optic endoscope was introducedintroduced
In 1968 ERCP was introducedIn 1968 ERCP was introduced In 1974 Endoscopic sphincterotomyIn 1974 Endoscopic sphincterotomy In 1979 PEGIn 1979 PEG In 1980 Endoscopic injection sclerotherapyIn 1980 Endoscopic injection sclerotherapy In 1980 Endoscopic ultrasonographyIn 1980 Endoscopic ultrasonography In 1983 Electronic (charge coupled device) endoscopeIn 1983 Electronic (charge coupled device) endoscope
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ENDOSCOPYENDOSCOPYTwo typesTwo types a. Rigid endoscope a. Rigid endoscope
b. Flexible endoscope b. Flexible endoscope
Now a days rigid type is virtually obsolete though Now a days rigid type is virtually obsolete though some surgeons still use this traditional instrument some surgeons still use this traditional instrument
It needs skill to introduce though there is It needs skill to introduce though there is significant risk of perforationsignificant risk of perforation
Probably better for examination of the lower Probably better for examination of the lower pharynx and cricopharyngeal areapharynx and cricopharyngeal area
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1 Function buttons, e.g., video recorder remote control2 Freeze button3 Suction button4 Air/water button5 Instrument channel6 Locking device7 Angling wheel (right/left)8 Angling wheel (up/down)
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Video processor (above) and light source (below)
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Tip of Endoscope
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Handling the EndoscopeHandling the Endoscope
The control head of the endoscope is held in the left hand.
The index and middle fingers activate the suction and air/water valves.
Many examiners operate the angulation control wheels with the right hand, but an endoscopist with large hands can also manage these controls with the left hand.
This leaves the right hand free to manipulate the insertion tube, which is advantageous in some situations.
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PRINCIPLES OF ENDOSCOPYOF ENDOSCOPY
InIn all flexible endoscopic system light is all flexible endoscopic system light is transmitted down the endoscope shaft to transmitted down the endoscope shaft to illuminate the surface to be examined.illuminate the surface to be examined.
The reflected image is conveyed back to the The reflected image is conveyed back to the endoscopist via one of two different endoscopist via one of two different modalitiesmodalities
A. Fiber opticsA. Fiber optics
B. ElectronicsB. Electronics
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Fiber optic EndoscopyFiber optic Endoscopy
In the fiber optics, a fixed lens at the end of In the fiber optics, a fixed lens at the end of the instrument shaft focuses the image on the instrument shaft focuses the image on internal fiber optic bundle.internal fiber optic bundle.
The fiber optic bundle is 2-3mm wide &is The fiber optic bundle is 2-3mm wide &is composed of 20,000-40,000 individual fine composed of 20,000-40,000 individual fine glass fibers, each approximately 10mm in glass fibers, each approximately 10mm in diameter.diameter.
The image undergoes a series of internal The image undergoes a series of internal reflection with in each fiber as it is reflection with in each fiber as it is transmitted up the bundle.transmitted up the bundle.
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Electronic EndoscopyElectronic Endoscopy
Most endoscopes currently produced are electronic.Most endoscopes currently produced are electronic. In these system the image is reflected onto a charge In these system the image is reflected onto a charge
coupled device [CCD] chip mounted on the end of coupled device [CCD] chip mounted on the end of instrument shaft. instrument shaft.
These chips contain thousands of light sensitive points These chips contain thousands of light sensitive points [ “Pixels”]. [ “Pixels”].
The greater the number of pixels, the better the The greater the number of pixels, the better the resolution.resolution.
Current chips contain 100,000 to 300,000 pixels.Current chips contain 100,000 to 300,000 pixels. The image is then transmitted through wires instead The image is then transmitted through wires instead
of light bundles to additional electronics in the of light bundles to additional electronics in the instrument head.instrument head.
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Advantages of video endoscopeAdvantages of video endoscope
The endoscopist can stand erect and watch the The endoscopist can stand erect and watch the television monitor without any interruptiontelevision monitor without any interruption
The intraluminal view and the lesions present within The intraluminal view and the lesions present within can be seen with more clarity by more than one can be seen with more clarity by more than one person in the endoscopy roomperson in the endoscopy room
Therapeutic procedures are easier with a video Therapeutic procedures are easier with a video endoscopeendoscope
The video endoscopes are water tight instruments and The video endoscopes are water tight instruments and can be immersed in cleaning solutionscan be immersed in cleaning solutions
Endoscopic pictures can be made readily available Endoscopic pictures can be made readily available with the help of printerwith the help of printer
In video endoscope the images of tumors, ulcers & In video endoscope the images of tumors, ulcers & polyps can be faithfully transferred to the television polyps can be faithfully transferred to the television monitor in their natural colors.monitor in their natural colors.
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Gastrointestinal EndoscopyGastrointestinal Endoscopy
Types of Gastrointestinal EndoscopyTypes of Gastrointestinal Endoscopy
Esophagogastroduodenoscopy (Upper GI Esophagogastroduodenoscopy (Upper GI Endoscopy)Endoscopy)
Small Bowel Enteroscopy (Jejunoscopy)Small Bowel Enteroscopy (Jejunoscopy) Colonoscopy (Lower GI Endoscopy)Colonoscopy (Lower GI Endoscopy) SigmoidoscopySigmoidoscopy Endoscopic Retrograde Endoscopic Retrograde
Cholangiopancreatogram (ERCP)Cholangiopancreatogram (ERCP)
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Upper Gastrointestinal Upper Gastrointestinal EndoscopyEndoscopy
HeartburnHeartburn
Dysphagia or odynophagiaDysphagia or odynophagia
Hematemesis or melenaHematemesis or melena
Dyspepsia or upper Dyspepsia or upper abdominal painabdominal pain
Unexplained weight loss or Unexplained weight loss or anemiaanemia
Evaluation of abnormal Evaluation of abnormal Barium meal X-rayBarium meal X-ray
Suspected malabsorptionSuspected malabsorption
Control of bleedingControl of bleeding
Dilation of strictureDilation of stricture
Removal of foreign Removal of foreign bodiesbodies
Removal of polypsRemoval of polyps
Tumor ablationTumor ablation
Diagnostic Indications Therapeutic Indications
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Upper Gastrointestinal Upper Gastrointestinal EndoscopyEndoscopy
Contraindications to Upper GI EndoscopyContraindications to Upper GI Endoscopy
Uncooperative patientUncooperative patient
Hemodynamically unstable patientHemodynamically unstable patient
Suspected perforationSuspected perforation
cervical spine disorderscervical spine disorders
Soon after a myocardial infarctionSoon after a myocardial infarction
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Upper Gastrointestinal Upper Gastrointestinal EndoscopyEndoscopy
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Cleaning and Disinfection Cleaning and Disinfection
Meticulous cleaning of the endoscope with clean and Meticulous cleaning of the endoscope with clean and filtered water immediately after use, is necessary to filtered water immediately after use, is necessary to keep the instrument clean of organic debris like blood, keep the instrument clean of organic debris like blood, dried gastric juice and food particles. It is scrubbed dried gastric juice and food particles. It is scrubbed with a sponge or soft brush.with a sponge or soft brush.
After a thorough cleaning, the next step is to disinfect After a thorough cleaning, the next step is to disinfect the scope against cross infection.the scope against cross infection.
The commonly used disinfectants areThe commonly used disinfectants are
a. 2% Glutarldehyde (CIDEX)a. 2% Glutarldehyde (CIDEX)
b. Iodophor (Betadine-providone Iodine)b. Iodophor (Betadine-providone Iodine)
c. 70% ethyl or isopropyl alcoholc. 70% ethyl or isopropyl alcohol
d. Ethylene oxide (ETO)d. Ethylene oxide (ETO)
e. Formaldehyde vapoure. Formaldehyde vapour
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Patient preparationPatient preparation
Fasted for at least 4 – 6 hrs more time forFasted for at least 4 – 6 hrs more time for
GOO.GOO. Before the study dentures & eye glasses should be removed.Before the study dentures & eye glasses should be removed. If intervention is anticipated, a recent coagulation profile If intervention is anticipated, a recent coagulation profile
&platelet count should be within safe ranges.&platelet count should be within safe ranges. Prophylactic antibiotics indicated in Prophylactic antibiotics indicated in
a. Sclerotherapy.a. Sclerotherapy.
b. Previous endocarditis.b. Previous endocarditis.
c. Recent vascular prosthesis.c. Recent vascular prosthesis.
d. For PEG tube placements.d. For PEG tube placements.
e. Patients with prosthetic heart valves.e. Patients with prosthetic heart valves.
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Method Two squirts of lidocaine sprayed into the pharynx or lidocaine viscus can be used.
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Check ListCheck List
24 hours before the examination
Confirm indication Check contraindications Necessary lab tests ordered? (blood count,
coagulation) Antibiotic prophylaxis? Informed consent obtained? Patient instructed about fasting? Cardiac pacemaker? Risk factors? (heart, lung, coagulation, general
health)
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Immediately before the examination
Patient welcomed to the unit, greeted by name Signed consent form? Dentures removed? Defoaming agent administered? Coagulation tested? If necessary: peripheral venous access?
(especially with sedation and for interventions) Equipment check? (air, suction) Endoscope tip lubricated Pharyngeal anesthesia (if desired) Contact with patient: “Here we go.”
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During the examination Talk to the patient, explain what is
happening. Keep the patient in a left lateral position. Observe the patient (sweating,
restlessness, facial expression, gestures, pain manifestations, breathing, skin color).
If in doubt: pulse oximetry, echocardiogram (ECG) monitoring.
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Inserting the Endoscope
Blind Insertion Direct-Vision Insertion In the blind insertion method, the endoscope is
first passed over the base of the tongue toward the hypopharynx under external visual control.
With proper technique, the instrument tip can be advanced just to the introitus of the upper esophageal sphincter, at which time the patient is instructed to swallow.
Endoscope insertion is contraindicated while the patient is coughing or taking a deep breath, as this will inevitably lead to tracheal intubation
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Diagnostic techniqueDiagnostic technique
inspection is often easier during withdrawal, when the inspection is often easier during withdrawal, when the viscera are well distended with air.viscera are well distended with air.
-the endoscope is advanced to the esophago-gastric -the endoscope is advanced to the esophago-gastric junction. Noting the ‘Z’ LINE, where the white junction. Noting the ‘Z’ LINE, where the white sqammous esophageal mucosa meets red columnar sqammous esophageal mucosa meets red columnar gastric epithelium.gastric epithelium.
Importance of ‘Z’ Line inImportance of ‘Z’ Line in a. ph probe placement.a. ph probe placement. b. Endoscopic Anti-reflux procedures.b. Endoscopic Anti-reflux procedures. c. determine if a GE Junction lesion is gastric or c. determine if a GE Junction lesion is gastric or esophageal in origin.esophageal in origin.
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-entry into the duodenal bulb is recognized by the -entry into the duodenal bulb is recognized by the typical granular, pale mucosa.typical granular, pale mucosa.
-finally, the second portion of the duodenal is entered -finally, the second portion of the duodenal is entered by advancing to the superior duodenal angle. by advancing to the superior duodenal angle.
-when scope in the antrum either prior to entering or -when scope in the antrum either prior to entering or after with drawing from the duodenal bulb tip can be after with drawing from the duodenal bulb tip can be rotated through 180 degree in either direction to rotated through 180 degree in either direction to visualize fundus &cardia.visualize fundus &cardia.
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Upper Gastrointestinal Upper Gastrointestinal EndoscopyEndoscopy
Normal Esophagus Normal Stomach Normal Duodenum
Duodenal UlcerGastric UlcerEsophagitis
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Gastric ulcer
Bleeding gastric ulcersGastric ulcer
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Esophageal Varices
Esophageal Varices Bleeding esophageal varices
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Angiodysplasia of the stomachAngiodysplasia of the stomach
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Gastric varices
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Mallory Weiss Tear Esophagitis
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Diagnostic proceduresDiagnostic procedures
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GI- EndoscopyGI- Endoscopy Can remove Can remove
polyps, coagulate polyps, coagulate active bleeding active bleeding sites, sites, sclerotherapy of sclerotherapy of esophageal esophageal varices, dilate varices, dilate strictures & obtain strictures & obtain biopsy samplesbiopsy samples
Often guided by Often guided by ultrasoundultrasound
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Therapeutic EndoscopyTherapeutic Endoscopy
Endoscopic treatmentEndoscopic treatment Upper Endoscopy is the procedure of choice in Upper Endoscopy is the procedure of choice in
majority of patients with an acute upper majority of patients with an acute upper gastrointestinal bleeding, for the following gastrointestinal bleeding, for the following reasons: reasons:
– It can define the source of bleeding in the majority of It can define the source of bleeding in the majority of patients with an upper gastrointestinal bleeding.patients with an upper gastrointestinal bleeding.
– It can stratify the patients risk of rebleeding.It can stratify the patients risk of rebleeding.
– It can provide endoscopic therapy for esophageal and It can provide endoscopic therapy for esophageal and gastric varices, peptic ulcer disease, Dieulafoy's lesion, gastric varices, peptic ulcer disease, Dieulafoy's lesion, vascular malformations and tumors.vascular malformations and tumors.
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Therapeutic optionsTherapeutic options
For Non variceal bleedingFor Non variceal bleeding
1. Injection therapy1. Injection therapy
2. Thermal energy2. Thermal energy
3. Endoscopic clipping 3. Endoscopic clipping
For Variceal bleedingFor Variceal bleeding
1. Sclerotherapy1. Sclerotherapy
2. Band ligation2. Band ligation
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Injection TherapyInjection Therapy
Materials Endoscope Suction pumps Water jet Single-lumen injection needles for
epinephrine and polidocanol, double-lumen needles for fibrin glue Epinephrine 1:10 000 in physiological saline
solution, 1% polidocanol, fibrin glue
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Duodenal ulcer (Clipping)Duodenal ulcer (Clipping)
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Argon plasma coagulationArgon plasma coagulation
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Esophageal Varices (Band Esophageal Varices (Band ligation)ligation)
Band ligation of esophageal varices
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Therapeutic optionsTherapeutic options
Percutaneous endoscopic Gastrostomy & Percutaneous endoscopic Gastrostomy & jejunostomyjejunostomy
for PEJ ; paediatric colonoscope with 160 cm flexible for PEJ ; paediatric colonoscope with 160 cm flexible scope is used.scope is used.
Foreign body extraction.Foreign body extraction. Dilation of strictureDilation of stricture
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Instruments used for foreign Instruments used for foreign body removalbody removal
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Therapeutic EndoscopyTherapeutic Endoscopy
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Small bowel enteroscopySmall bowel enteroscopy
Capsule endoscopyCapsule endoscopy Double baloon endoscopyDouble baloon endoscopy Paediatric colonoscopePaediatric colonoscope
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Capsule EndoscopyCapsule Endoscopy
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Capsule EndoscopyCapsule Endoscopy
Capsule Endoscopy is a new technology that allows the doctor to see the middle part of the intestinal tract, the jejunum where no scope can currently go.
especially helpful in finding the source of unexplained intestinal bleeding and Crohn’s disease.
Patient swallows a wireless video camera about the size of a large vitamin
Patient goes normally about their day while the capsule records images throughout the digestive tract.
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Capsule EndoscopyCapsule Endoscopy
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Capsule EndoscopyCapsule Endoscopy
Capsule endoscopy is intended for visualization of Capsule endoscopy is intended for visualization of the small bowel mucosathe small bowel mucosa
It may be used as a tool in the detection of It may be used as a tool in the detection of abnormalities of the small bowel in adults and abnormalities of the small bowel in adults and children from 10 years of age and upchildren from 10 years of age and up
Diagnostic Indications
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Capsule EndoscopyCapsule Endoscopy
Capsule endoscopy is contraindicated for use under the following Capsule endoscopy is contraindicated for use under the following conditions:conditions:
In patients with known or suspected gastrointestinal obstruction, In patients with known or suspected gastrointestinal obstruction, strictures, or fistulas based on the clinical picture or pre-strictures, or fistulas based on the clinical picture or pre-procedure testing and profileprocedure testing and profile
In patients with cardiac pacemakers or other implanted electro In patients with cardiac pacemakers or other implanted electro medical devicesmedical devices
In patients with swallowing disordersIn patients with swallowing disorders
Severe gastro paresisSevere gastro paresis
Pseudo obstructionPseudo obstruction
Contraindications
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DisadvantagesDisadvantages
No therapeutic facilityNo therapeutic facility Long duration of procedureLong duration of procedure It does not localize the exact site of the pathologyIt does not localize the exact site of the pathology
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Double balloon enteroscopy Double balloon enteroscopy
In 2000 it was introducedIn 2000 it was introduced It consists of thin endoscope with 200cm length and It consists of thin endoscope with 200cm length and
over tube 145cm length.over tube 145cm length. Soft latex balloon is attached at the tip of both the Soft latex balloon is attached at the tip of both the
tubes which can be inflated & deflated.tubes which can be inflated & deflated. It can be inserted through duodenum or anusIt can be inserted through duodenum or anus
AdvantagesAdvantages a. Tremendous diagnostic & therapeutic purpose a. Tremendous diagnostic & therapeutic purpose
in small bowel.in small bowel.
b. Altered small bowel anatomy (patients who b. Altered small bowel anatomy (patients who require ERCP after Roux-en-y gastric by pass) require ERCP after Roux-en-y gastric by pass)
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DisadvantagesDisadvantages
a. Long duration; 1-3 hrs to completea. Long duration; 1-3 hrs to complete
b. Needs expertise b. Needs expertise
c. Patient discomfortc. Patient discomfort
d. Needs general anesthesia d. Needs general anesthesia
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Endoscopic Retrograde Endoscopic Retrograde CholangiopancreatogramCholangiopancreatogram
William mckune a surgeon introduced ERCP IN I968William mckune a surgeon introduced ERCP IN I968
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Endoscopic Retrograde Endoscopic Retrograde CholangiopancreatogramCholangiopancreatogram
IndicationsIndications Obstructive jaundice Obstructive jaundice
(benign or malignant)(benign or malignant) Ascending cholangitis Ascending cholangitis Gallstone pancreatitisGallstone pancreatitis Unexplained jaundice or Unexplained jaundice or
elevated LFT’selevated LFT’s Bile duct injury or leak Bile duct injury or leak
after cholecystectomyafter cholecystectomy Chronic pancreatitisChronic pancreatitis Pancreatic cancerPancreatic cancer Suspected Sphincter of Suspected Sphincter of
Oddi dysfunctionOddi dysfunctionConversly, the availability of Conversly, the availability of
ERCP should not be an ERCP should not be an indication for its liberal indication for its liberal use. use.
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Patient preparationPatient preparation
Normal coagulation profiles are more relevant in Normal coagulation profiles are more relevant in ERCP, especially if sphincterotomy or endoprosthesis ERCP, especially if sphincterotomy or endoprosthesis insertion is contemplated.insertion is contemplated.
Prophylactic antibiotics are usually administered.Prophylactic antibiotics are usually administered. Oropharynx is anaesthetized with local anesthesia.Oropharynx is anaesthetized with local anesthesia.
I.V. sedation and glucagon (0.5-1.0 mg) administered I.V. sedation and glucagon (0.5-1.0 mg) administered to decrease duodenal motility.to decrease duodenal motility.
Position of the patient most commonly in “ PRONE Position of the patient most commonly in “ PRONE POSITION”.POSITION”.
The I.V. access is preferred in the Right hand. The I.V. access is preferred in the Right hand.
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Diagnostic technique of ERCPDiagnostic technique of ERCP 90 degree side viewing scope is used.90 degree side viewing scope is used. Scope rides along the greater curvature towards the Scope rides along the greater curvature towards the
pyloruspylorus 7F cathetar with radio opaque tip is used for 7F cathetar with radio opaque tip is used for
diagnostic purpose.diagnostic purpose. Endoscopic spincterotomyEndoscopic spincterotomy
Indications; a. CholedocholithiasisIndications; a. Choledocholithiasis
b. Sphincter of oddi dysfunctionb. Sphincter of oddi dysfunction
c. Acute cholangitisc. Acute cholangitis
d. Stent placementd. Stent placement
e. Acute gall stone pancreatitise. Acute gall stone pancreatitis
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Endoscopic Retrograde Endoscopic Retrograde CholangiopancreatogramCholangiopancreatogram
Pancreatic cancer with dilated bile duct and pancreatic duct (Double Duct sign)
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Endoscopic Retrograde Endoscopic Retrograde CholangiopancreatogramCholangiopancreatogram
Gallstone impacted at ampulla, sphincterotomy being done and stones removed
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Complications of EndoscopyComplications of Endoscopy
Perforation, more in therapeutic endoscopyPerforation, more in therapeutic endoscopy
AspirationAspiration
Pancreatitis, cholangitis, perforation & bleeding after Pancreatitis, cholangitis, perforation & bleeding after ERCP.ERCP.
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Lower Gastrointestinal Lower Gastrointestinal EndoscopyEndoscopy
Chronic diarrheaChronic diarrhea Rectal bleedingRectal bleeding Iron deficiency anemiaIron deficiency anemia Unexplained abdominal Unexplained abdominal
painpain Constipation, change in Constipation, change in
bowel habits or stool bowel habits or stool calibercaliber
Unexplained weight lossUnexplained weight loss Evaluation of abnormal Evaluation of abnormal
Barium enema x-rayBarium enema x-ray Personal or family history Personal or family history
of colon cancerof colon cancer Personal history of IBDPersonal history of IBD
Control of bleedingControl of bleeding Removal of polypsRemoval of polyps Tumor ablationTumor ablation Dilation of strictureDilation of stricture Colonic decompressionColonic decompression Reduction of sigmoid Reduction of sigmoid
volvulus volvulus
Diagnostic Indications Therapeutic Indications
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Lower Gastrointestinal Lower Gastrointestinal EndoscopyEndoscopy
Contraindications to Lower GI EndoscopyContraindications to Lower GI Endoscopy
Uncooperative patientUncooperative patient Hemodynamically unstable patientHemodynamically unstable patient Suspected perforationSuspected perforation Suspected colonic obstructionSuspected colonic obstruction Suspected diverticulitisSuspected diverticulitis Soon after a myocardial infarctionSoon after a myocardial infarction Deep ulcerations Severe ischemic necroses Fulminant colitis
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The sigmoidoscope measures only 60 cm in total length. Because of its high degree of maneuverability, it is sometimes used in patients where the indications for examination are limited to the sigmoid colon and rectum.
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Lower Gastrointestinal Lower Gastrointestinal EndoscopyEndoscopy
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(Lower GI endoscopy)(Lower GI endoscopy) PreprocedurePreprocedure Consent formConsent form LaxativeLaxative
evening before evening before & enema or & enema or suppository 1 hr suppository 1 hr before Full liquid before Full liquid diet 1-3 days diet 1-3 days beforebefore
PEGLECPEGLEC
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Lower Gastrointestinal Lower Gastrointestinal EndoscopyEndoscopy
Normal Colon Colon Cancer
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Therapeutic colonoscopyTherapeutic colonoscopy
Colon Polyp and Polypectomy
PolypPolyp
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Schematic illustration of endoscopic mucosal resectionusing suction cap technique
a Colonoscope with suction cap and asymmetrical snare.b Submucosal injection with NaCl solution and epinephrine.c Lifting the flat lesion after submucosal injection.d Suctioning the flat lesion into the cap and resection with a snare.e Recovering the resected lesion by suction into the cap.
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Future EndoscopyFuture Endoscopy ChromoendoscopyChromoendoscopy Narrow band imagingNarrow band imaging High resolution magnification endoscopyHigh resolution magnification endoscopy
GOALS;GOALS;
a. Recognition of early gastric and colorectal a. Recognition of early gastric and colorectal cancercancer
b. To allow accurate discrimination of dysplasia b. To allow accurate discrimination of dysplasia grade in areas of Barrett’s esophagus or grade in areas of Barrett’s esophagus or quiescent quiescent ulcerative colitis ulcerative colitis
c. To aid polyp detectionc. To aid polyp detection
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ChromoendoscopyChromoendoscopy
The most widely available techniqueThe most widely available technique
Chromoendoscopy refers to the intravital staining of epithelial structures during the endoscopic examination
It involves the topical application of stains or It involves the topical application of stains or pigments to improve tissue localization, pigments to improve tissue localization, characterization or diagnosischaracterization or diagnosis
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Stains used in chromoendoscopy
Absorptive stains − Lugol solution − Methylene blue − Toluidine blue Contrast stains − Indigo carmine Reactive stains − Congo red − Phenol red
Absorptive stains are taken up by specialepithelial cells and can differentiate cells according to whetherthey are stained or unstained. Contrast stains cause relativelymarked enhancement of intestinal mucosa and are often used inmagnification endoscopy. Reactive stains are used to identifycertain secretions in which the stain induces a color reaction
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Magnification Endoscopy
Principle. Magnification endoscopy, known also as zoom endoscopy, can be used for the detailed endoscopic evaluation of suspiciousareas, especially after staining
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Endoscopic UltrasoundEndoscopic Ultrasound
The ultrasound probe is The ultrasound probe is placed at the tip of the placed at the tip of the endoscopeendoscope
Allows ultrasonography of Allows ultrasonography of organs from a close distanceorgans from a close distance
Individual layers of the GI Individual layers of the GI wall are visualized as five wall are visualized as five distinct layers of alternating distinct layers of alternating hyper and hypo ecogenicity hyper and hypo ecogenicity
Can be used to take fine Can be used to take fine needle aspiration samples needle aspiration samples from adjoining from adjoining regions/organsregions/organs
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Endoscopic UltrasoundEndoscopic Ultrasound
A T3 Rectal Tumor on EUS
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Indications of EUSIndications of EUSPANCREATICPANCREATIC a. FNAC of malignancya. FNAC of malignancy b. Drainage of fluid collectionsb. Drainage of fluid collections c. Lymph node samplingc. Lymph node sampling d. Assess portal venous systemd. Assess portal venous system e. Intraductal ultrasounde. Intraductal ultrasoundHEPATOBILIARYHEPATOBILIARY a. Detect stonesa. Detect stones b. Periportal lymph nodesamplingb. Periportal lymph nodesampling c. Biopsy of liver massc. Biopsy of liver mass ESOPHAGEALESOPHAGEAL a. Esophageal cancer staginga. Esophageal cancer staging GastricGastric a. Gastric cancer staging a. Gastric cancer staging b. Evaluation of submucosal massesb. Evaluation of submucosal masses
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