general endoscopy

1. ENDOSCOPY IN
SURGERY
PRESENTED BY :-
ROLL NO. 88-92

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

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”

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

10. Types of endoscopy

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.

28. ADVANTAGE
• Direct mucosal visualisation
• Patient acceptibility
• Lack of ionising radiation

29. DISADVANTAGE
• Cost
• Reporting time
• Impaction
• Difficult to localise the lesion
• High miss rate

30. Latest techniques in
endoscopy

31. Endoscopic retrograde cholangiopancreatography
(ERCP)
• Endoscopy and x-ray are combined to treat
pancreatic and bile disease.

32. Chromoendoscopy
Dyes are installed before
endoscopy to identify any lesions.

34. Endoscopic ultrasound
High frequency sound waves are
used to identify the digestive
system and lung diseases.

36. Narrow band imaging
Filtered light is used for better
visualization of internal organs