6. Upper GI Endoscopy: Step by Step
ï§ Recognize the landmarks
ï§ Art of reaching each landmarks
7. Pre Endoscopic Ritual 1
Equipment check list:
ï§ Endoscopy leak tested and disinfected and
ready
ï§ Processor unit, monitor working
ï§ Water bottle full and suction unit ready
ï§ Check suction, air flow and water flow
ï§ Mouth guard
ï§ Accessories stand by
8. Pre Endoscopic Ritual 2
Patient check list:
ï§ Know the indication
ï§ Verify any contraindication
ï§ Drug history and co morbidity
ï§ Informed consent
ï§ Fasting for 6 hours
ï§ No denture or loose tooth
9. Success depends on Sound
Basics
ï§ Ambidextrous
ïș Left hand on control head
ïș Right hand on endoscopy shaft
ï§ Benefit of body movement
ï§ Ergonomics during endoscopy
14. Language of the Wheels/Buttons
âąBig Wheel
âąSmall Wheel
âąTowards you
âąAway from you
âąSuperior button
âąSuction
âąInferior Button
âąInsufflation of air
âąInstillation of water
15. Language of the Insertion tube
âąClock wise twist
âąAnti-clock wise twist
Navigate using
âąWheel
âąShaft &
âąyour Body
26. Puddle of fluid greets you!
Enter the body of stomach
1st
,,,,,,,
27. 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
28. 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
29. Big wheel towards you
Clockwise twist of shaft
Push the scope
3 Times!
36. Enter 2nd
part: do 3 maneuvers
Big wheel: towards U
Small wheel: away from U
Turn your body to right to face the monitor
37. 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!
38. Pull back to shorten the scope
To 60cm at Incisor teeth
39. Return to stomach
Fall Back to Antrum
Enter along the long route
Exit along the short route
40. Long route Vs Short route
Entry
Exit
Along the greater curvature
Lesser curvature
41. Steps of Endoscopy 11/12
Incisura
Fundus
Antrum
Body of stomach
8
2
While staying in antrum ,
turn the Big wheel little bit towards youâŠ
Incisura
42. Retreat and retroflex !
(big wheel fully towards U) to see
Incisura and then Fundus.
47. Abandon the procedure
ï§ When patient is restless/ not co- operative
ï§ Any indication of cardio respiratory distress
ï§ Any indication of major complication
ïș Perforation/false passage/aspiration etc
48. Post endoscopic steps
ï§ Endoscopy:
ïș Cleaning and disinfection
ï§ Patient:
ïș Discuss the findings and their implications
ïș Give a written report
ïș Advice regarding further management
49. Patient instructions after
the procedure
âąNo solid foods for 30 minutes after the examination.
âą Allow for after effects of sedation
(no driving, no hazardous work activities for 24 hours).
âą Report any complications (pain, bleeding, fever).
50. Safety During Endoscopy
ï§ Pre endoscopy check list
ï§ Vigilance during endoscopy
ï§ Administer Nasal O2
ï§ ECG/Pulse Oximeter
ï§ Need for anesthetist
ï§ Access to Defibrillator/Resuscitation team
ï§ Disinfected Endoscope and accessories
Safety of Patient Safety of Staffs Safety of Equipments