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Steps of diagnostic endoscopy

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tips and tricks of diagnostic endoscopy

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Steps of diagnostic endoscopy

  1. 1. Welcome to EFIAGES Course… Dr. Basil Hirschowitz 1960 Father of Flexible Endoscopy Prof Dr. B.Krishna Rau Father of Endoscopy In India
  2. 2. I A G E S EFIAGES FAGIE
  3. 3. Upper GI Endoscopy: Step by Step  Recognize the landmarks  Art of reaching each landmarks
  4. 4. Pre Endoscopic Ritual 1 Equipment check list:  Endoscopy leak tested and disinfected and ready  Processor unit, monitor working  Water bottle full and suction unit ready  Check suction, air flow and water flow  Mouth guard  Accessories stand by
  5. 5. Pre Endoscopic Ritual 2 Patient check list:  Know the indication  Verify any contraindication  Drug history and co morbidity  Informed consent  Fasting for 6 hours  No denture or loose tooth
  6. 6. Success depends on Sound Basics  Ambidextrous  Left hand on control head  Right hand on endoscopy shaft  Benefit of body movement  Ergonomics during endoscopy
  7. 7. The Endoscopy room…
  8. 8. Endoscopy Room Lay Out X2X1
  9. 9. Treat the monitor like a clock!
  10. 10. Language of the Wheels/Buttons •Big Wheel •Small Wheel •Towards you •Away from you •Superior button •Suction •Inferior Button •Insufflation of air •Instillation of water
  11. 11. Language of the Insertion tube •Clock wise twist •Anti-clock wise twist Navigate using •Wheel •Shaft & •your Body
  12. 12. Steps of Endoscopy No & Position of Staffs: 1+ 4
  13. 13. Steps of Endoscopy.1 •Oropharynx 12 o clock 6 o clock Glimpse of Epiglottis Tongue Uvula
  14. 14. Steps of Endoscopy 2  Laryngopharynx Cricopharynx : closed state 1 2 3 1. Vocal cord 2. Arytenoid fold 3. Piriform fossa
  15. 15. Dock and wait at 15cm Sneak down cricopharynx as patient swallows(not when he coughs or struggles Oops!
  16. 16. Steps of Endoscopy 3 •Entering esophagus
  17. 17. Navigate straight till U see Z line at 40cm
  18. 18. Esophagus is empty! Peristalsis present
  19. 19. Steps of Endoscopy 4/5 Z line NBI/ I scan/FICE image
  20. 20. Puddle of fluid greets you! Enter the body of stomach 1st ,,,,,,,
  21. 21. Inspect/suction any residue and insufflate and orient yourself: remember the clock Lesser curve : 12 o clock Greater curve: 6 o clock Anterior wall : 9 o clock Posterior wall : 3 o clock 12 6 9 3
  22. 22. Steps of Endoscopy 6 Greater curve at 6 o clock position Posterior wall at 3 O clock Anterior wall At 9 o clock Enter along the long route Exit along the short route Lesser Curve at 12 o clock
  23. 23. Big wheel towards you Clockwise twist of shaft Push the scope 3 Times!
  24. 24. Proceed to pylorus…
  25. 25. Enter the pylorus when it is at the centre and wide open and scope is straight
  26. 26. Enter the pylorus when it is at the centre! Pylorus
  27. 27. Steps of Endoscopy 9/10 D1 D2 Bulbar part Post bulbar part superior duodenal angle D2 Ampulla
  28. 28. See the bulbar part Anterior wall: 9 o clock Posterior wall: 3 o clock
  29. 29. Post Bulbar region Superior Duodenal angle
  30. 30. Enter 2nd part: do 3 maneuvers Big wheel: towards U Small wheel: away from U Turn your body to right to face the monitor
  31. 31. 1. Big Wheel turn towards you 2. Small wheel turn away from you/ or Twist the shaft clock wise 3. Turn to face the monitor!
  32. 32. Pull back to shorten the scope To 60cm at Incisor teeth
  33. 33. Return to stomach Fall Back to Antrum Enter along the long route Exit along the short route
  34. 34. Long route Vs Short route Entry Exit Along the greater curvature Lesser curvature
  35. 35. Steps of Endoscopy 11/12 Incisura Fundus Antrum Body of stomach 8 2 While staying in antrum , turn the Big wheel little bit towards you… Incisura
  36. 36. Retreat and retroflex ! (big wheel fully towards U) to see Incisura and then Fundus.
  37. 37. Big wheel fully towards you & Pull back
  38. 38. Cardia/Crus Big wheel fully towards you along with shaft movement & your body movement 360 degree panoramic view of cardia
  39. 39. J Maneuver But do not pull the scope beyond 50cm level
  40. 40. Do distensibility test of stomach. Suck and remove the scope Finally,
  41. 41. Abandon the procedure  When patient is restless/ not co- operative  Any indication of cardio respiratory distress  Any indication of major complication  Perforation/false passage/aspiration etc
  42. 42. Post endoscopic steps  Endoscopy:  Cleaning and disinfection  Patient:  Discuss the findings and their implications  Give a written report  Advice regarding further management
  43. 43. Patient instructions after the procedure •No solid foods for 30 minutes after the examination. • Allow for after effects of sedation (no driving, no hazardous work activities for 24 hours). • Report any complications (pain, bleeding, fever).
  44. 44. Safety During Endoscopy  Pre endoscopy check list  Vigilance during endoscopy  Administer Nasal O2  ECG/Pulse Oximeter  Need for anesthetist  Access to Defibrillator/Resuscitation team  Disinfected Endoscope and accessories Safety of Patient Safety of Staffs Safety of Equipments
  45. 45. Endoscope Disinfection protocol
  46. 46. Remember 3 things for life!  Oral Cavity  3 structures  Tongue, Soft palate ,Glimpse of Epiglottis,  Cricopharynx  3 structures  Vocal cord, arytenoid fold, piriform fossa  Esophagus  3 areas of narrowing  15/25/40cm  Stomach  3 steps to reach pylorus  Big wheel towards you, clock wise twist, Push/3 times  Duodenum  3 steps to enter D2  Big wheel towards you, clock wise twist, turn body to right  On J Maneuver  3 structures  Incisura, fundus, cardia

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