2. WHAT IS ENDOSCOPY ???
• Endoscopy Greek Word “Endo”means
“Inside” “Skopeein ”means “To See”
• Examination of the interior of a canal or
hollow viscus by means of a special
instrument, such as an endoscope.
• Direct viewing interior of an organ is often
very helpful in determining the cause of a
problem & helpful in establishing a diagnosis.
3. Parts of Endoscope
• Parts of an Endoscope
» A thin long tube-Rigid/Flexible
» Alens/lens system
» Light transmitting system
» Eyepiece
» Control System
• Has a channel through which tiny instruments
such as forceps,scissors can be manipulated
4.
5. Rigid Endoscope
• Relay lens system transmit the image to
viewer
• Better image quality & light efficiency
6. Fibreoptic Endoscope
• Based on Optical viewing bundles
• 2–3 mm in diameter and contains 20000–40000 fine glass
fibers, each close to 10μm in diameter
• Advantages:-
• Fiberoptic bundles are extremely flexible, and an image can
be transmitted even when tied in a knot
• Small diameter
• Direct view (monitor not necessary)
• Limitations :-
• Image quality can never equal that of a rigid lens system or a
video-endoscope
• Limited number of “pixels”
7.
8. Video-endoscopes
• Mechanically similar to fiber-endoscopes
• A CCD chip and supporting electronics mounted at the tip
• To and fro wiring replacing the optical bundle
• Further electronics and switches occupying the site of the ocular
lens on the upper part of the control head
• Advantages :-
• Improved image quality
• Removing need to hold the instrument close to the eye has
hygienic advantages (avoidance of splash contamination)
• Improved instrument design and handling
• Limitations
• No direct viewing
• Can not be made < 5 mm
11. PRINCIPLES OF ENDOSCOPY
• Endoscopy minimally invasive diagnostic
medical procedure used to evaluate interior
surface of an organ.
• Endoscope may have rigid or flexible tube
inserted into body. It has ability to looking
inside the body using a variety of very small
cameras attached to flexible or rigid tube. It
facilitates direct viewing the interior of an
organ is often very helpful in determining the
cause of a problem.
12. • An endoscope is a flexible tube equipped
with lenses and a light source.
Illumination is done by the help of a
number of optical fibers.
• Video endoscopy performed by attaching
in microchip camera at the insertion
tube, setup image is viewed on a video
monitor.
13. INDICATIONS
UPPER GI ENDOSCOPY
• Visualised till 2nd part of
Duodenum,Oesophagogastroduodenoscopy
• For 3rd part & beyond ligament of Treitz
longer enteroscope required
• For ampulla side viewing scope is used
• Brushing,Aspirate,Biopsy,Bedside H.pylori test
can be done
14. Diagnostic Indications
• Symptoms are persistent despite appropriate
empirical therapy
• Symptoms associated with warning signs such
as intractable vomiting, anaemia, weight loss,
dysphagia or bleeding
• Workup of anemia,malabsorption,chronic
diarrhoea
• Surveillance of neoplasia in high risk group
like FAP , Peutz–Jeghers syndrome
15. Therapeutic Indications
• UGI bleed of any etiology
• Band ligation for oesophageal varices
• Sclerotherapy with thrombin-based glues to control gastric
and duodenal varices
• Injection sclerotherapy with heater probe vessel obliteration
or haemo-clip application for peptic ulcer with an active
arterial spurt
• Benign esophageal/Pyloric stricture dilatation
16. • Achalasia by pneumatic balloon dilatation or peroral
endoscopic myotomy
• GERD by tightening the loose GEJ by plication or by the
application of radial thermal energy
• Gastric ballon insertion for Obesity
• PEG tube in patients unable to maintain oral nutritional intake
• EMR & ESD in Barrett’s high-grade dysplasia and early
oesophageal adenocarcinoma.
17. Endoscopy of Small Bowel
• Requirement to visualise, biopsy and treat the
small bowel is far less than in the stomach,
biliary tree or colon
• Indications :-
a) GI blood loss in case of normal
UGIE/Colonoscopy
b) Malabsorption
c) Crohn’s disease
d) Neoplasia surveillance
18. • Standard endoscope can reach upto 100cm of
small bowel but require high sedation
• Sonde endoscope is nearly obsolete
• Radiological tools can’t take biopsy & aren’t
therapeutic
• Led to Capsule endoscopy & Single/double
balloon enteroscopy
19. Flexible sigmoidoscopy
• Majority of indications are for malignancy
only.
• Very few therapeutic indications are:
a) Detorsion of sigmoid volvulus
b) Foreign body removal
c) Distal stricture management
20. Colonoscopy
• Therapeutic uses:
• Hemostasis: Recent severe but currently inactive
bleeding
• Stigmata of recent hemorrhage such as active
bleeding, adherent clot, nonbleeding visible vessel
• Hemostasis achieved in same manner as UGIT
• Angiodysplasia and diverticulosis (MC cause of
lower GI bleeding)
• Thermal techniques should be used with caution in
proximal colon for hemostasis
21. Double BalloOn Enteroscopy
• Push & pull enteroscopy
• Fiberoptic method to visual the entire small bowel
• Two balloons are inflated and deflated in sequence to
move the endoscope through the bowel
22. Advantages
• Visualization of the entire
small bowel to the terminal
ileum
• Therapeutic interventions
• Allows biopsy
• Placement of stents or
dilation of small bowel
strictures
Disadvantages
• Technically difficult
• Very time consuming
• Needs admission
• Higher risk of small bowel
perforation
• Case reports of pancreatitis
and intestinal necrosis
• Reported incidents of
aspiration and pneumonia
23. Indications of biliary stenting
• Malignant strictures of CBD –favorable for lesion
below bifurcation
• Benign strictures due to iatrogenic trauma or due
to penetrating trauma
• Sclerosing cholangitis
• Choledochocoele
24. Indications for pancreatic stenting
• Bypass ductal leaks and strictures
• Pancreatic divisum-for minor papilla stenting
• Pancreatic fistula
• Pancreatic pseudocyst – when cyst in
connection with main pancreatic duct
25. CAPSULE ENDOSCOPY
• Capsule endoscopy was first used in humans
in 1999.
• Consists of an optical dome and lens, two
light-emitting diodes, a processor, a battery, a
transmitter and an antenna encased in a
resistant coat the size of a large vitamin pill
• Non invasive
• Not suitable in stricture or obstruction cases
26. HOW DOES CAPSULE ENDOSCOPY
WORK?
• Capsule is initially stored in a case containing a magnet that inhibits
capsule activation. Once it taken out of the case, the LEDs start to
flash and the capsule start to transmit.
• Eight aerial leads that are attached around the patient’s abdomen
collect data.
• Capsule ingested as any other capsule.
• Patient can drink clears immediately, but no solid food for 3 hours.
• Attached to the leads is the recorder and the patient should report
back if it stops recording for any reason.
• Belt and aerial should be worn for 8 hours after swallowing or until
the recorder stops recording.
• Recorder and aerials are returned, but the capsule is disposable!
• Images are downloaded and processed prior to interpretation.
