ENDOSCOPY 5 Lower objectives position procedure instrumens

Lower Gastrointestinal Endoscopy (Figs above)

Objective

The examination of the interior of the colon for viewing and biopsy.

Position

Usually left lateral.

Anesthesia

Surface and sedation with IV diazepam.

Procedure

1.      Patient is sedated with diazepam.

2.      Lubricated colonoscope introduced.

3.      View rectum through eyepieces.

4.      Advance colonoscope under vision keeping to the center of of the colon.

5.      Entire colon can be examined while withdrawing instruments.

6.      Biopsies or cytology specimens can also be obtained.

Instruments

•       Colonofiberscope.

•       Fiberoptic light source/diathermy power supply.

•       Biopsy forceps (these includes those suitable for cutting, grasping, taking cytology specimens, etc).

•       Accessories for endoscopic diathermy (e.g. snares, cutter, electrodes).

•       Colon stiffening tube.

•       Lubricant, e.g. lignocaine (xylocaine) gel.

•       Water container/irrigator.

•       Carbon dioxide gas source.

•       Medical vacuum.

•       Camera. 

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ENDOSCOPY 4 upper GI Procedure position steps instruments

Upper Gastrointestinal Endoscopy (Figs above)

Objective

Examination and biopsy of esophagus, stomach and duodenum.

Position

Left lateral or sitting.

Anesthesia

Surface and sedation with IV diazepam.

Procedure

1.      Patient is sedated with intravenous diazepam.

2.      Plastic mouth-guard.

3.      Lubricated fiberscope.

4.      Passed into mouth over the tongue.

5.      Patient asked to swallow.

6.      Instruments advanced.

7.      No force should be used.

•       As instruments enter esophagus examine through eyepiece.

•       Advance instrument under vision into stomach.

Instruments and Equipments Required

•       Suitable fiberscope (e.g., forward, or side viewing).

•       Fiberoptic light source/diathermy power supply.

•       Mouth guard.

•       Biopsy forceps (these include those suitable for cutting, grasping, taking cytology specimens, etc).

•       Accessories for endoscopic diathermy (e.g., snares, knives, electrodes).

•       Angled tongue depressor.

•       Pharyngeal spray.

•       Topical anesthetic, e.g. 1 percent lignocaine (xylocaine).

•       Lubricant, e.g. lignocaine (xylocaine) gel.

•       Esophageal bougies and tubes sizes 16 and 18 Charriere gauge may be required water container/irrigator.

•       Medical vacuum.

•       Camera if required.

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ENDOSCOPY 3 gastroscopes duodenoscopes colonoscopes

GASTROINTESTINAL FIBERSCOPES
(INCLUDING GASTRoSCOPES,
DUODENOSCOPES AND COLONOSCOPES)

Based on the angle of view, there are three types of instruments:

1.      Forward or oblique (foreoblique) viewing for examination and biopsy This is suitable for examining the esophagus, most of the stomach and the upper part of the duodenum.

2.      Side or lateral viewing for examination, biopsy and operative procedures in the duodenum This is needed when full examination of esophagus, stomach, duodenum and biliary system is required. This includes the fundus of the stomach and the duodenal bulb.

3.      Forward viewing with two channels for complex operative procedures This is generally larger in diameter than the previous two and has suitable dimension channels incorpo­rated for operating instruments. A wide range of procedures can be undertaken.

         All three types of instruments can be obtained from several manufacturers.

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ENDOSCOPE 2 Parts & light source

LIGHT SOURCE & PARTS      

  This ensures that cold light is passed to the instrument or endoscope since the heat is left in the light source box

•       Special lamps such as quartz iodine, metal halide and xenon have been developed to give a higher intensity of light of up to 500 Watts.

         The fiber light bundle is connected at one end to the light source and at the other to the endoscope (Fig. above).

•       It contains a bundle of up to 20,000 flexible optical fibers which can conduct light but not capable of carrying an image (E above).

•       The bundles transmit a prefocussed light of high intensity and uniform density to the endoscope.

•       The bundle’s outer covering is metal and PVC, and is extremely flexible.

•       In addition, a separate set of upto 36,000 optical fibers cap­able of carrying an image terminating proximally at an eyepiece, and distally at a lens at the end of the endoscope (F above).

•       Both these sets of optical fibers are contained in a protective sheath of endoscope, generally this sheath incorporates additional channels for:

         a.      Suction (G as shown above).

         b.      Gas inflation/irrigation (H as shown above).

         c.       A passage for flexible biopsy or operative forceps and electrodes (Fig. above).

         d.      Some special instruments used through this port are shown in Figure above

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