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Endoscopy in surgery
- 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 • Relaylens system transmit the image to viewer • Better image quality & light efficiency
- 6. Fibreoptic Endoscope • Basedon 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 similarto 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
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- 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 endoscopeis 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 • Symptomsare 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 • UGIbleed 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 bypneumatic 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 SmallBowel • 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 endoscopecan 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 • Majorityof 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 ofthe 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 biliarystenting • 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 pancreaticstenting • 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 • Capsuleendoscopy 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 CAPSULEENDOSCOPY 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 mucosalvisualisation • Patient acceptibility • Lack of ionising radiation
- 29. DISADVANTAGE • Cost • Reportingtime • Impaction • Difficult to localise the lesion • High miss rate
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- 31. Endoscopic retrograde cholangiopancreatography (ERCP) •Endoscopy and x-ray are combined to treat pancreatic and bile disease.
- 32. Chromoendoscopy Dyes are installedbefore endoscopy to identify any lesions.
- 34. Endoscopic ultrasound High frequencysound waves are used to identify the digestive system and lung diseases.
- 36. Narrow band imaging Filteredlight is used for better visualization of internal organs