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  1. 1. Esophagogastroduodenoscopy
  2. 5. Esophagus Normal Stricture Polyp Varices
  3. 6. Stomach Normal Ulcer Gastritis
  4. 7. Duodenum Normal Ulcer( NSAID) Mass
  5. 8. Biopsy
  6. 9. Indications <ul><li>Diagnostic </li></ul><ul><li>Surveillance </li></ul><ul><li>Therapeutic </li></ul><ul><li>Confirmation of diagnosis/biopsy </li></ul>
  7. 10. Diagnostic <ul><li>Unexplained anemia (usually along with a colonoscopy) </li></ul><ul><li>Upper gastrointestinal bleeding as evidenced by hematemesis or melena </li></ul><ul><li>Persistent dyspepsia in patients over the age of 40-45 years </li></ul><ul><li>Heartburn and chronic acid reflux - this can lead to a precancerous lesion called Barrett's esophagus (an abnormal change (metaplasia) in the cells of the lower end of the esophagus thought to be caused by damage from chronic acid exposure, or reflux esophagitis. The normal lining of the esophagus (squamous epithelium) is replaced by an intestinal-type lining (columnar epithelium). </li></ul><ul><li>Persistent vomiting </li></ul><ul><li>Dysphagia - difficulty in swallowing </li></ul><ul><li>Odynophagia - painful swallowing </li></ul>
  8. 11. Surveillance <ul><li>Surveillance of Barrett's esophagus (an abnormal change (metaplasia) in the cells of the lower end of the esophagus ) </li></ul><ul><li>Surveillance of gastric ulcer or duodenal ulcer </li></ul><ul><li>Occasionally after gastric surgery </li></ul>Barrett's esophagus
  9. 12. Therapeutic <ul><li>Treatment ( banding/sclerotherapy ) of esophageal varices </li></ul><ul><li>Injection therapy (e.g. epinephrine in bleeding lesions ) </li></ul><ul><li>Cutting off of larger pieces of tissue with a snare device (e.g. polyps, endoscopic mucosal resection) </li></ul><ul><li>Application of cautery to tissues </li></ul><ul><li>Retrieval of foreign bodies that have been ingested </li></ul><ul><li>Tamponade of bleeding esophageal varices with a balloon </li></ul><ul><li>Application of photodynamic therapy for treatment of esophageal malignancies </li></ul><ul><li>Tightening the lower esophageal sphincter </li></ul><ul><li>Dilating or stenting of stenosis or achalasia </li></ul><ul><li>Percutaneous endoscopic gastrostomy (feeding tube placement) </li></ul><ul><li>Endoscopic drainage of pancreatic pseudocyst </li></ul><ul><li>Endoscopic retrograde cholangiopancreatography (ERCP) combines EGD with fluoroscopy </li></ul><ul><li>Endoscopic ultrasound (EUS) combines EGD with 5-12 MHz ultrasound imaging </li></ul>
  10. 13. Confirmation of diagnosis / biopsy <ul><li>Abnormal barium swallow or barium meal </li></ul><ul><li>Confirmation of celiac* disease </li></ul><ul><li>(via biopsy) </li></ul><ul><li>A genetic disease of malabsorption </li></ul><ul><li>Patient cannot tolerate protein called gluten, found in wheat, rye, and barley </li></ul><ul><li>-Immune system responds by damaging the villi of small intestine </li></ul>*
  11. 14. Complications <ul><li>The complication rate is about 1 in 1000. </li></ul><ul><ul><li>aspiration pneumonia </li></ul></ul><ul><ul><li>bleeding </li></ul></ul><ul><ul><li>perforation </li></ul></ul><ul><ul><li>cardiopulmonary problems </li></ul></ul>
  12. 15. Limitations <ul><li>Problems of gastrointestinal function are usually not well diagnosed by endoscopy since motion or secretion of the gastrointestinal tract are not easily inspected by EGD. </li></ul><ul><li>Problem in small bowel below 120cm </li></ul><ul><li>Irritable bowel syndrome and functional dyspepsia is not diagnosed with EGD, but EGD may be helpful in excluding other diseases that mimic these common disorders </li></ul>
  13. 16. Contraindications <ul><li>Acute myocardial infarction </li></ul><ul><li>Poor cardiorespiratory reserve (e.g. unstable angina or severe emphysema) </li></ul><ul><li>Hypoxemia with respiratory distress </li></ul><ul><li>Hypotension and shock, regardless of etiology. </li></ul><ul><li>Massive upper GI bleeding with hypotension where emergency surgery is clearly appropriate. </li></ul><ul><li>Patients on anti-coagulation </li></ul><ul><li>Uncontrolled hypertension. </li></ul><ul><li>Un co-operative patient. </li></ul>
  14. 17. Capsule Endoscopy
  15. 18. Recorder Unit Antenna Lead Real Time Viewer Endocapsule
  16. 19. Capsule
  17. 24. EndoCapsule Images of Jejunum Normal villi structure                                Active bleeding      
  18. 25. HIV                         Parasite
  19. 26. Capsule Endoscopy <ul><li>A technology that uses a swallowed video capsule to take photographs of the inside of the esophagus, stomach, and small intestine </li></ul><ul><li>As the capsule travels through the esophagus, stomach, and small intestine, it takes photographs rapidly. The photographs are transmitted by the radio transmitter to a small receiver that is worn on the waist of the patient who is undergoing the capsule endoscopy. At the end of the procedure, approximately 24 hours later, the photographs are downloaded from the receiver into a computer, and the images are reviewed by a physician. The capsule is passed by the patient into the toilet and flushed away. </li></ul>
  20. 27. Limitations of capsule endoscopy <ul><li>Abnormalities in some areas of the intestine are missed because of rapid transit of the capsule and blurred , uninterpretable photographs. </li></ul><ul><li>At times, transit is so slow that the capsule examines only part of the small intestine before the battery fails . </li></ul><ul><li>If abnormalities are discovered that require surgical resection or further investigation, it may be difficult to determine where in the small intestine the abnormality is and thereby help direct therapy. </li></ul><ul><li>If there are narrow areas due to scarring (strictures) or tumors in the small intestine, the capsule can get stuck in the narrow area and cause an obstruction of the intestine that requires surgical removal of the capsule. (For this reason, in patients who are suspected of having a stricture, a self-dissolving, dummy capsule is swallowed first. If the dummy capsule sticks, it can be seen on an x-ray of the abdomen and the location of the stricture determined. Because it dissolves with time, however, the obstruction will resolve without surgery, and the real capsule will not be swallowed.) </li></ul><ul><li>Finally, reviewing the tens of thousands of photographs is very time consuming for the conscientious physician </li></ul>
  21. 28. Diseases can be diagnosed <ul><li>Angiodysplasias (collections of small blood vessels located just beneath the inner intestinal lining that can bleed intermittently and cause anemia) </li></ul><ul><li>Small intestinal tumors such as lymphoma, carcinoid tumor, and small intestinal cancer </li></ul><ul><li>Crohn ’ s disease of the small intestine </li></ul>