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General Surgery
Endoscopy and Endoscopic Intervention
Built from Maingot's Abdominal Operations
What’s inside
13 sections · 185 slides
Overview
- Scope of flexible endoscopy today
- Fields covered by interventional endoscopy
The flexible endoscope
How the picture is made, and how the instrument is built
- Image transmission in a fiberoptic endoscope
- Videoendoscopes and the charge coupled device
- Aim of the newer imaging methods and chromoendoscopy
- Lugol's solution and magnification endoscopy
- Yield of magnification and confocal microendoscopy
- Narrow band imaging
- White light and narrow band views of Barrett's esophagus
- Autofluorescence and light scattering spectroscopy
- Optical coherence tomography
- Cross-section of the esophageal wall on optical coherence tomography
- Wall layers resolved by cross-sectional imaging
- Image documentation during endoscopy
- Controls on the endoscope head piece
- Air, water, suction and the biopsy channel
- Rotation, torque and loop formation
- Variable stiffness control on a colonoscope
- Shape-locking device and self-propelled colonoscopes
- Endoscopic training for surgical residents
Patient assessment, sedation and monitoring
Making the procedure safe before the scope goes in
- Preprocedural patient assessment
- Patients needing extra vigilance, and how they are monitored
- Limits of pulse oximetry and the role of capnography
- Sedation agents, reversal and titration
- Cardiopulmonary complications of endoscopic sedation
Upper gastrointestinal endoscopy
Indications, preparation, technique and tissue sampling
- Diagnostic and therapeutic roles of upper endoscopy
- Alarm symptoms that call for upper endoscopy
- The nine alarm symptoms in full
- Contraindications to upper endoscopy
- Coagulopathy and suspected perforation
- Preparation before upper endoscopy
- Antibiotic prophylaxis and choice of scope
- Intubation of the cervical esophagus
- Route of the endoscope during upper endoscopy
- Landmarks recorded in the esophagus
- Surveying the stomach
- Entering the duodenum and the short position
- Retroflexion in the stomach
- Retroflex view of a large paraesophageal hernia
- Retroflex view of an intact fundoplication
- Forceps biopsy and surveillance protocols
- Brush cytology
Endoscopic control of gastrointestinal bleeding
Thermal and non-thermal ways to shut a bleeding point
- Role of endoscopy in upper gastrointestinal bleeding
- Categories of endoscopic haemostatic therapy
- Choosing a haemostatic technique
- Success and risk of thermal haemostasis
- Contact thermal techniques
- Bipolar endoscopic cautery device
- Argon plasma coagulation
- Gastric antral vascular ectasia treated by argon plasma coagulation
- Injection sclerotherapy
- Agents used for injection therapy
- Endoscopic treatment of esophageal varices
- Endoscopic band and loop ligation
- Endoscopic clips placed for haemostasis
Endoscopic mucosal resection and ablation
Removing and destroying early lesions without an operation
- Scope of endoscopic mucosal resection
- Steps of saline lift mucosal resection
- Saline lift mucosal resection
- Sessile colon polyp before mucosal resection
- Sessile colon polyp after submucosal injection
- Polypectomy site after saline lift resection
- Cap-assisted and band-assisted resection
- Complications of endoscopic mucosal resection
- Endoscopic submucosal dissection
- Endoscopic mucosal ablation
- The HALO 90 radiofrequency ablation device
Endoscopic enteral access
Feeding and decompression tubes placed with a scope
- Indications for endoscopic enteral access
- Contraindications to endoscopic enteral access
- Percutaneous endoscopic gastrostomy
- Preparation and positioning for gastrostomy
- Choosing the puncture site and confirming a safe tract
- Pull and push gastrostomy techniques
- Internal bumper checked at second endoscopy
- Introducer and assisted gastrostomy techniques
- Gastrostomy with jejunal extension
- Aspiration and the limits of tube feeding
- Direct percutaneous endoscopic jejunostomy
Foreign bodies, dilation and enteral stents
Clearing, stretching and propping open the gut lumen
- Who swallows foreign bodies
- Urgency and airway protection
- Removing coins and food boluses
- Sharp objects, batteries and drug packets
- Assessment after foreign body removal
- Eosinophilic esophagitis found after food bolus impaction
- Migrated sutures at a previous gastrojejunostomy
- Endoscopic dilation of strictures
- Dilator types and how far to go in one session
- Balloon dilation and waist ablation
- Enteral stents and their delivery systems
- Reach of the different stent delivery systems
- Covered and uncovered enteral stents
- Uncovered enteral stents
Endoluminal treatment of gastroesophageal reflux
A generation of devices, and what became of them
- Overview of endoluminal antireflux devices
- EndoCinch and Stretta
- The NDO Plicator
- Enteryx polymer implantation and its withdrawal
- Gatekeeper and EsophyX
Endoscopic retrograde cholangiopancreatography
Reaching the bile and pancreatic ducts through the duodenum
- Origins of ERCP
- Why ERCP is reserved for treatment
- Indications for endoscopic retrograde cholangiopancreatography
- Biliary indications for ERCP
- Pancreatic and ductal injury indications for ERCP
- Preparation and passage of the side-viewing duodenoscope
- Reaching the short-scope position and the papilla
- Cannulating the bile and pancreatic ducts
- Two types of sphincterotomy
- Impacted common bile duct stone at the ampulla
- Sphincterotomy with a pull-wire sphincterotome
- Major papilla after sphincterotomy
- Clearing common bile duct stones
- Common bile duct stone on cholangiogram
- Extracted bile duct stone lying in the duodenum
- Preoperative ERCP and sphincter of Oddi dysfunction
- Manometry, cholangitis and gallstone pancreatitis
- Indications for biliary and pancreatic endoprostheses
- Contrast leaking from an accessory bile duct
- Bile leak resolved after six weeks of stenting
- Transpapillary biliary stent for a duct leak
- Placing and sizing a biliary endoprosthesis
- Choosing between plastic and metal biliary stents
- Distal bile duct stricture from a pancreatic head cancer
- Pancreatic duct stenting
- Guide wire in the pancreatic duct before stenting
- Temporary plastic pancreatic stent in place
- Pancreatic duct stones and pseudocyst drainage
- Transvisceral drainage and endoscopic necrosectomy
- Post-ERCP pancreatitis
- Infection and bleeding after ERCP
- Perforation during and after ERCP
- Managing perforation from ERCP manipulation
Small bowel enteroscopy
Reaching the part of the gut that was out of reach
- Capsule endoscopy
- Older approaches to the small bowel
- Balloon-assisted deep enteroscopy
- Practicalities of balloon enteroscopy
Lower gastrointestinal endoscopy
Colonoscopy from insertion to polypectomy and stenting
- Origins and screening role of colonoscopy
- Diagnostic and therapeutic indications for colonoscopy
- Diagnostic indications for colonoscopy
- Therapeutic indications for colonoscopy
- Contraindications to colonoscopy
- Bowel preparation and drug precautions
- Principles of colonoscope handling
- Stapled anastomosis at the rectosigmoid level
- Starting the colonoscopy
- Advancing through the rectum and sigmoid colon
- Multiple diverticula in the sigmoid colon
- Loop reduction, splenic flexure and transverse colon
- Hepatic flexure, ascending colon and terminal ileum
- Cecal landmarks confirming a complete examination
- Lipomatous appearance of the ileocecal valve
- Withdrawal and inspection
- Retroflexed view of the rectal vault and dentate line
- Bleeding and perforation after colonoscopy
- Sites of perforation and postpolypectomy syndrome
- Polypectomy of small and pedunculated polyps
- Small pedunculated polyp suitable for snare polypectomy
- Sessile polyps and mucosal resection in the colon
- Polyp retrieval, tattooing and surveillance intervals
- Lower gastrointestinal bleeding: sources and preparation
- Timing, diverticular bleeding and angiodysplasia
- Colonoscopic decompression in pseudo-obstruction
- Technique and limits of colonoscopic decompression
- Colonic stenting
- Placing a stent across an obstructing colon lesion
- Obstructing sigmoid colon cancer before stenting
- Guide wire passed across an obstructing lesion
- Relief of obstruction after colonic stent deployment
Endoscopic ultrasound and future developments
Seeing through the wall, and operating without a scar
- Role of endoscopic ultrasound
- Endoscopic ultrasound in pancreatic, hepatobiliary and mediastinal disease
- Endoscopic ultrasound in luminal and retroperitoneal disease
- What endoscopic ultrasound is used for
- Technique of endoscopic ultrasound
- Natural orifice translumenal endoscopic surgery
- Limitations and the tools that answer them
- Takeaways: the instrument and the image
- Takeaways: intervention and its risks
- References
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- Maingot's Abdominal Operations, 12th Edition