This document describes the journey of flexible endoscopy at the Department of Surgery of Dhaka Medical College & Hospital in Bangladesh. It discusses the history of endoscopy and lists mentors who supported the development of their endoscopy suite. The suite is described along with equipment. The document focuses on their experience with colonoscopy, providing details on patient preparation, sedation used, and their single-handed painless technique without air insufflation. Outcomes of their first 720 colonoscopy cases are presented along with therapeutic procedures performed. Their efforts to train residents and conduct workshops on laparoscopic and endoscopic skills are also summarized.

1. A JOURNEY BY
FLEXIBLE
ENDOSCOPY
DR.MASFIQUE AHMED BHUIYAN
MBBS(DMC) FCPS(SURGERY)
LAPARO-ENDOSCOPIC SURGEON
DEPARTMENT OF SURGERY
DHAKA MEDICAL COLLEGE & HOSPITAL.

2. HISTORY OF ENDOSCOPY

6. IN 2013 WE,DEPARTMENT OF SURGERY
STARTED OUR JOURNEY

7. LAPAROSCOPY CAN NOT BE
COMPLETED WITHOUT FLEXIBLE
ENDOSCOPY

8. GREATFULL TO THESE GREAT MENTORS
•PROF. M A HASHEM BHUIYA
•PROF. A Z M MOSTAQUE
HOSSAIN TUHIN
•PROF. A B M KHURSHID ALAM
•PROF. A H M TOWHIDUL ALAM
•PROF. AHMEDUL KABIR
•PROF.ABDUL HANIF TABLU
•PROF.K ABUL KALAM AZAD
•PROF . FAROQUE AHMED

9. OUR ENDOSCOPY SUITE

10. ENDOSCOPY SUITE (cont…..)

11. ENDOSCOPY SUITE (cont…..)

12. ENDOSCOPY SUITE (cont…..) Diathermy

13. ENDOSCOPY SUITE (cont…..) PROCESSOR

14. ENDOSCOPY SUITE (cont…..)

15. ENDOSCOPY SUITE (cont…..)
LAPARO-ENDOSCOPIC UNIT
DHAKA MEDICAL COLLEGE HOSPITAL
BANGLADESH

16. TIP OF ENDOSCOPE

17. REGULAR SUCTION DEVICE

18. DISINFECTANT

19. REPORTING STATION

20. • WE WILL SHARE OUR COLONOSCOPIC
EXPERIENCE

21. Indications of colonoscopy :
• Surveillance in persons with average and high risk for colon
cancer
• Faecal occult blood
• Iron deficiency anaemia
• Haematochezia
• Malaena with nondiagnostic UGI endoscopy
• After finding colonic polyps on sigmoidoscopy
• Adenocarcinoma metastasis to liver with unknown primary
• Follow up after colonoscopic removal of large sessile colonic
polyp
• Abnormal radiographic study ( contrast enema, virtual
colonoscopy)
• Colonic stricture
• Intraoperative colonoscopy to localise lesion for surgical removal

22. Patient source
• In Patient Department.
• Out Patient Department.

23. Patient preparation
• Adequate counseling.
• Valid informed written consent.
• Dietary modification.
• PEG sol
• USUAL AS BOWEL PREPARATION IN BOWEL
SURGERY.

24. SEDATION
30mg pethidine+1mg midazolam

25. HOW WE DID
• PAINLESS NON LOOP CAP
COLONOSCOPY
• COLONOSCOPY WITHOUT AIR THAT
MEANS LESS DISCOMFORT
• SINGLE HANDED TECHNIQUE

26. LIMITATION OF COLONOSCOPY
PROCEDURE
• SEVERE PAIN EXPERIENCE DURING THE
PROCEDURE
• GENERAL ANAESTHESIA
• LESS NUMNER OF EXPERTIES IN FLEXIBLE
ENDOSCOPY
• SURGEONS ARE RELACTANT TO DO
COLONOSCOPY

27. CONVENTIONAL COLONOSCOPY
• DIFFICULT
• PAINFULL FOR THE PATIENT
• NEED ASSISTANT
• LONG LEARNING CURVE
• CAECAL INTUBATION RATE IS LESS
• MORE CHANCE OF PERFORATION
• FAILURE RATE IS HIGH

28. OUR MISSION
• DEVELOPED A SPECIAL TECHNIQUE OF
COLONOSCOPY
• WHICH IS PAINLESS
• NO AIR NO DISCOMFORT
• WE USE WATER
• WE USE DISTAL ATTATCHMENT CAP
• MERGE ENDOSCOPY WITH LAPAROSCOPY

29. SINGLE HANDED TECHNIQUE

30. HOW TO HOLD THE SCOPE WITH LEFT
HAND

31. SINGLE MAN TECHNIQUE

32. SINGLE MAN TECHNIQUE

33. DISTAL ATTACHMENT CAP

34. WE ADOPTED TOMOAKI KARUBE
FROM JAPAN TECHNIQUE

35. • I WITH TOMOAKI KARUBE TRANSLATE THIS
BOOK IN ENGLISH AND IT WILL BE AVAILABLE
SOON BY INTERNATIONAL PUBLISHER.
• THIS IS ACTUALLY DESCRIPTION OF PAINLESS
NON LOOP TECHNIQUE OF COLONOSCOPY.
• ONE OF THE BEST BOOK OF COLONOSCOPY
TECHNIQUE IN JAPANEESE LANGUAGE AND
ALREADY PUBLISHED BY JAPANEESE MEDICAL
JOURNAL.

36. WHAT WE DID
Total number of procedure
720
Screening
20
Diagnostic
672
Therapeutic
28

37. SCREENING
TOTAL NUMBER 20
NORMAL FINDING 18
ABNORMAL FINDING 2

38. DIAGONOSTIC
TOTAL NUMBER 672
FINDING MALIGNANCY
ILEOCAECAL TB
CROHN’S
ULCERATIVE COLITIS

39. NORMAL RECTUM FROM INSIDE

40. NORMAL SIGMOID COLON

41. NORMAL TRANSVERSE COLON

42. NORMAL TRANSVERSE COLON

43. NORMAL CAECUM

44. APPENDICEAL ORIFICE

45. NORMAL ILEOCAECAL VALVE

46. PAINLESS NONLOOP CAP
COLONOSCOPY

47. THEREPEUTIC IN THIS SUITE
• VOLVULUS DEFLATION 10
• POLYPECTOMY 16
• EMR 2

48. COLOSCOPIC VOLVULUS DEFLATION
DEFLATION
Mr. Ali Haydar, 65 yrs old male admitted in emergency with sigmoid volvulus

49. VOLVULUS DEFLATION

50. HYBRID SURGERY

51. PICTURE OF HYBRID TECHNIQUE

52. REMOVED FOREIGN BODY

53. Flat broad base polyp which can not be
removed by conventional snaring

54. EMR

56. POLYPECTOMY

57. CONTINUED TRAINING PROGRAME
ENDOSCOPY WITH LAPAROSCOPY

58. HANDS ON WORKSHOP ORGANIZED BY
DEPARTMENT OF SURGERY
IN COLABORATION WITH 4 SOCIETIES:

59. HANDS ON WORKSHOP at KORMOCHARI HOSP

60. CODUCTING BASIC LAPARO-ENDOSCOPIC
TRAINING FOR RESIDENTS

61. Opening of new horizons to the Surgical
Trainees:

62. THANKS FOR PATIENCE HEARING
we know we have limitation but we
have the courage to overcome it.