Steps of Diagnostic Endoscopy

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EFIAGES Erode 2016 IAGES Endoscopy Fellowship Course:

EFIAGES Erode 2016 IAGES Endoscopy Fellowship Course Steps of Endoscopy…

Pre Endoscopic Check List:

Pre Endoscopic Check List 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

Pre Endoscopic Check List:

Pre Endoscopic Check List Patient check list: Know the indication Verity any contraindication Drug history and co morbidity known Informed consent Fasting for 6 hours No denture or loose tooth

Steps of Endoscopy Position of Staffs:

Steps of Endoscopy Position of Staffs

Define ‘Conscious Sedation’:

Define ‘Conscious Sedation’ The patient is able to make a purposeful response to verbal or tactile stimulation Both the ventilatory and cardiovascular function are maintained Use titrated dose of Midazolam Diazepam Profofol

Yes No:

Yes No

Steps of Endoscopy.1 :

Steps of Endoscopy.1 Oropharynx 12 o clock 6 o clock Glimpse of Epiglottis Tongue Uvula

Steps of Endoscopy 2/3:

Steps of Endoscopy 2/3 Laryngopharynx Entering esophagus Cricopharynx : closed state 1 2 3 R L


Dock and wait at 15cm Sneak down cricopharynx as patient swallows(not when he coughs or struggles Oops!


At 25cm level Aortic arch Left Bronchus Then Left Atrium


Navigate straight till U see Z line at 40cm


Esophagus is empty! Peristalsis present

Steps of Endoscopy 4/5:

Steps of Endoscopy 4/5 Lower third of Esophagus Z line


Little anti-clockwise rotation helps to see and slip through LOS and enter stomach


9 3 Puddle of fluid greets you!


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

Steps of Endoscopy 6 So 1st we see the Body of Stomach & not fundus:

Steps of Endoscopy 6 So 1 st we see the Body of Stomach & not fundus Greater curve at 6 o clock position Posterior wall at 3 O clock Anterior wall At 9 o clock


3 6 9 12 Big wheel towards you Clockwise twist of shaft Push the scope 3 Times!


Proceed to pylorus: Up and right: big wheel down(towards you) and twist the shaft clock wise


Enter the pylorus when it is at the centre and wide open and scope is straight

Enter the pylorus when it is at the centre!:

Enter the pylorus when it is at the centre! Pylorus

Steps of Endoscopy 9/10:

Steps of Endoscopy 9/10 D1 D2


See the bulbar part Anterior wall: 9 o clock Posterior wall: 3 o clock 9 3


1. Big Wheel turn towards you 2. Small wheel turn away from you/Twist The shaft clock wise


3. Turn to face the monitor! 4. Pull back to shorten the scope To 60cm at Incision teech


Enter 2 nd part: do 4 maneuvers Big wheel: towards U Small wheel: away from U Turn your body to right to face the monitor Pull and shorten the scope to 60cm

Return to stomach:

Return to stomach Fall Back to Antrum Enter along the long route Exit along the short route

Steps of Endoscopy 11/12:

Steps of Endoscopy 11/12 Incisura Fundus Antrum Body of stomach


Retreat back to pylorus and retroflex (big wheel fully towards U) to see Incisura and then Fundus. But do not pull the scope beyond 50cm level


Big wheel fully towards you Pull back


Do distensibility test of stomach. Suck and remove the scope

Abandon the procedure:

Abandon the procedure When patient is un co operative /restless Any indication of cardio respiratory distress: Any indication of major complication: Perforation/false passage/aspiration etc

Post endoscopic steps :

Post endoscopic steps Endoscopy: Cleaning and disinfection Patient: discuss the findings and their implications give a written report Advice regarding further management

Patient instructions after the procedure:

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 ).

Key Messages…:

Key Messages… Recognize the landmarks Art of reaching each landmarks Then , only then We shall be ready to recognize pathology Where it is & what it is!


Thank You

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