Patient presents with all the previous data in a big file.
Previous operations well illustrated graphically.
Previous endoscopic findings recorded & pictured.
Every patient appointed in advance, who will do the endoscopy.
Endoscopist will map the mucosa during entry & withdrawal.
Patients come to the endoscopy unit by appointment, 1-2 patients only at the same time.
Qualified nurse will welcome the patient in the waiting room, explain, take consent, give him/her antifoamimg agent to drink(semithscone + bicarbonate), xylocaine jell to keep in the mouth & throat for a period ( by an alarm watch given to the patient) then swallow or spit.
Patient enters to the endoscopy room, his belongings put in a specified container.
Endoscopist uses semithscone/bicarbonate to wash the mucosa through syringing to see have better view.
Esophagus: use NBI, ME, Iodine chromoendoscopy for diagnosis of early esophageal cancer & decide whether there is or no submucosal invasion to decide on doing ESD/EMR or send the patient for surgery or Chemoradiotherapy.
Suck excess iodine pooled in the stomach (irritant) & neutrilize by thiosulphate once the procedure is complete.
Map the antrum & incisura.
Go to the duodenum D1/D2.
Return to the antrum to do complete retroflexion to see the fundus by rotating the scope 360 degrees.
Suck any pooling fluids in the fundus totally.
Use IEE by NBI,ME,Indigocarmine to characterize any suspected lesion & avoid unnecessary biopsies.
Ⅰ Ⅱ Ⅲ S Ⅲ L Ⅳ Ⅴ N Ⅴ I Normal round crypts, regular Enlarged stellar crypts, regular Narrowed round pits, irregular Branched or gyrus-like crests Irregular surface Amorphous surface Elongated, sinuous crests Pit pattern （ Kudo & Turuta’s classification ）
Ⅰ Ⅱ Ⅲ S Ⅲ L Ⅳ Ⅴ N Ⅴ I normal pattern Hyperplastic polyp Serrated adenoma irregular pattern non-structure pattern regular pattern Pit pattern and treatment selection No treatment Endoscopic resection Surgery Endoscopic resection or Surgery Nonneoplastic Neoplastic, adenomatous Neoplastic, cancer