The document describes common anatomical landmarks seen during an upper endoscopy procedure. It lists the main areas examined, including the esophagus, stomach, and duodenum. Key landmarks are identified, such as the gastroesophageal junction and specific areas of the stomach and duodenum. Common findings and techniques for a thorough exam, such as retroflexion and applying torque, are also outlined.

1. Upper endoscopy
Mugemana Henri Paterne

2. Common anatomical landmarks
Anatomical landmarks during upper endoscopy.
● Label 1: mid-esophagus;
● Label 2: gastroesophageal junction;
● Label 3: gastric body;
● Label 4: gastric antrum;
● Label 5: incisura;
● Label 6: gastric fundus;
● Label 7: duodenal bulb;
● Label 8: second part of duodenum.

3. Common anatomical landmarks
➔ Epiglottis and Vocal Cords
➔ Scope maneuvered post to the epiglottis &
forward to upper esophageal sphincter (which is @
thyroid cartilage ~ 15-18 cm from the incisors)

4. Common anatomical landmarks
➔ Epiglottis and Vocal Cords
➔ Scope maneuvered post to the epiglottis &
forward to upper esophageal sphincter (which is @
thyroid cartilage ~ 15-18 cm from the incisors)
◆ Gentle pressure and insufflation

5. Esophagus: May be examined in details during the scope withdraw...
● ~ 25 cm of length
● Mucosa
○ Erythema
○ Erosions
○ Ulcerations
○ Strictures
○ Rings
○ Web
○ Varices
○ Diverticula

6. Esophagus
● ~ 25 cm of length
● Mucosa
○ Erythema
○ Erosions
○ Ulcerations
○ Strictures
○ Rings
○ Web
○ Varices
○ Diverticula

7. Esophagus__Los Angeles (LA) grading
● ~ 25 cm of length
● Mucosa
○ Erythema
○ Erosions
○ Ulcerations
○ Strictures
○ Rings
○ Web
○ Varices
○ diverticula

8. Esophagus__Los Angeles (LA) grading
● ~ 25 cm of length
● Mucosa
○ Erythema
○ Erosions
○ Ulcerations
○ Strictures
○ Rings
○ Web
○ Varices
○ diverticula

9. Esophagus__Los Angeles (LA) grading
● ~ 25 cm of length
● Mucosa
○ Erythema
○ Erosions
○ Ulcerations
○ Strictures
○ Rings
○ Web
○ Varices
○ diverticula

10. Esophagus__Los Angeles (LA) grading
● ~ 25 cm of length
● Mucosa
○ Erythema
○ Erosions
○ Ulcerations
○ Strictures
○ Rings
○ Web
○ Varices
○ diverticula

11. Esophagus
● ~ 25 cm of length
● Mucosa
○ Erythema
○ Erosions
○ Ulcerations
○ Strictures
○ Rings
○ Web
○ Varices
○ diverticula

12. Esophagus
● ~ 25 cm of length
● Mucosa
○ Erythema
○ Erosions
○ Ulcerations
○ Strictures
○ Rings
○ Web
○ Varices
○ Diverticula
Endoscopic dilation of Esophageal Benign Stricture

13. Esophagus
● ~ 25 cm of length
● Mucosa
○ Erythema
○ Erosions
○ Ulcerations
○ Strictures
○ Rings
○ Web
○ Varices
○ Diverticula
Distal esophagus; intermittent dysphagia, Rx (if symptomatic): dilation +/- acid suppression

14. Esophagus
● ~ 25 cm of length
● Mucosa
○ Erythema
○ Erosions
○ Ulcerations
○ Strictures
○ Rings
○ Web
○ Varices
○ Diverticula

15. Esophagus
● ~ 25 cm of length
● Mucosa
○ Erythema
○ Erosions
○ Ulcerations
○ Strictures
○ Rings
○ Web
○ Varices
○ Diverticula

16. Esophagus
● ~ 25 cm of length
● Mucosa
○ Erythema
○ Erosions
○ Ulcerations
○ Strictures
○ Rings
○ Web
○ Varices
○ Diverticula

17. Esophagus
● ~ 25 cm of length
● Mucosa
○ Erythema
○ Erosions
○ Ulcerations
○ Strictures
○ Rings
○ Web
○ Varices
○ Diverticula

18. Esophagus
● ~ 25 cm of length
● Mucosa
○ Erythema
○ Erosions
○ Ulcerations
○ Strictures
○ Rings
○ Web
○ Varices
○ Diverticula
○ Mallory weiss tear

19. Esophagus
● ~ 25 cm of length
● Mucosa
○ Erythema
○ Erosions
○ Ulcerations
○ Strictures
○ Rings
○ Web
○ Varices
○ Diverticula
○ Mallory weiss tear
○ Inlet patches

20. Esophagus
● ~ 25 cm of length
● Mucosa
○ Erythema
○ Erosions
○ Ulcerations
○ Strictures
○ Rings
○ Web
○ Varices
○ Diverticula
○ Mallory weiss tear
○ Inlet patches
○ Papilloma

21. Stomach
● Attention to
○ Food debris
○ FB
○ Retained fluid
■ Suction of any food in fundus to improve visualization & reduction of
reflux to esophagus which may lead to aspiration

22. Stomach
● Antrum … pylorus
○ Pylorus
■ Ulcers
■ Erosions
■ Gastric antral vascular ectasia (GAVE)

23. ● Duodenal bulb
○ Endoscope is advanced till the duodenal sweep
(duodenal convexity)
■ Rotate the shoulder 45 degree to the right
■ Move little wheel forward & big wheel backward &
simultaneously pulling back the scope
● Paradoxical advancement of the scope through
the sweep and the 2nd part of the duodenum
where circular duodenal folds are seen
Duodenum
DUODENAL SWEEP

24. ● 2nd part of duodenum mucosa
○ Ulcerations
○ Erosions
○ Scalloped (or loss of ) duodenal folds
■ Underlying celiac diseases
○ If biopsy indicated
■ Biopsy forceps introduced into the working channel
■ Then opened by the assistance of the 2nd
operator
Duodenum
LOSS OF DUODENAL FOLD
Scalloped duodenal
folds

25. ● 2nd part of duodenum … Ampulla
○ Side viewing endoscope
■ Ampullary mass
■ Periampullary diverticula
Duodenum
Endoscopic view of periampullary diverticulum (red arrow), with papilla arising on
a Abdominal CT revealing a dilation of both the common bile duct (arrow head) and
the main pancreatic duct. b Upper gastrointestinal endoscopy revealing a mass
lesion (arrow) in the ampulla of Vater

26. ● On withdraw of the scope towards
the stomach
○ Examine the duodenal sweep cuz of
limited visualization on initial entry
○ It is common to fall into the
stomach,reentry into the duodenum if the
visualisation was not adequate
Duodenum
Endoscopic view of duodenal sweep (arrow)

27. Duodenum
Duodenitis. (a) Erosive. (b) Erythematous

28. ● Examination of all portions of the stomach
○ Retroflexion maneuver
■ The stomach is distended with air
■ Advance the scope to the region of angularis,
to the lesser curvature near the antrum
● While simultaneously flexing the tip of
the scope thru dialing the big wheel in
downward direction to the maximum
extent
Stomach

29. ● Examination of all portions of the stomach
○ Applying torque
■ 360 degree view
● Gastric incisura
● Gastric fundus
● Gastric cardia
● GE junction
Stomach

30. ● Examination of all portions of the stomach
○ Applying torque with your right hand
■ 360 degree view
● Gastric incisura
(arrow)
● Gastric fundus
● Gastric cardia
● GE junction
Stomach
Endoscopic view of pyloric ring (arrow head)
Normal: Round, reactive and patent

31. ● Examination of all portions of the
stomach
○ Applying torque
■ 360 degree view
● Gastric incisura
● Gastric fundus
● Gastric cardia
● GE junction
Stomach

32. ● Examination of all portions of the stomach
○ Applying torque
■ 360 degree view
● Gastric incisura
● Gastric fundus
● Gastric cardia (arrow head)
● GE junction
Biopsy the suspicion site: to look for H. pylori and metaplasia
➢ Narrow Band Imaging (NBI): used to enhance the details
of surface of the mucosa & further evaluation
Stomach

33. ● Examination of all portions of the stomach
○ Applying torque
■ 360 degree view
● Gastric incisura
● Gastric fundus
● Gastric cardia (arrow head)
● GE junction
Biopsy the suspicion site: to look for H. pylori and metaplasia
➢ Narrow Band Imaging (NBI): used to enhance the details
of surface of the mucosa & further evaluation
Stomach

34. Stomach_Hill grading
● Retroflexion
○ Hiatal hernia

35. ● Withdraw of the scope towards the GEJ
○ Greater curvature
○ Lesser curvature
Stomach

36. Stomach
Endoscopic aspects of portal hypertensive gastropathy
considered. A: "cherryred spots" with different nomenclature in
each classification as follows: discrete red spots-McCormack;
cherry-red spots-New Italian Endoscopy Club (NIEC); B: Red-
point lesions-NIEC; C: Isolated red marks-Baveno; D: confluent

37. Stomach
White nipple sign --- do not disturb
Stigmata of bleeding in varices
Red wale sign

38. ● ~ 40 cm from the incisors
● Narrow Band Imaging can be used for further
evaluation of esophageal mucosa
○ Suspected or established Barrett’s
esophagus
● Biopsy if indicated -> may need to apply
torque
● On withdrawal of the endoscope, air and
secretions should be suctioned to reduce the
risk of distention and aspiration
Gastroesophageal Junction
Endoscopic findings of Barrett's esophagus. (A) Short-segment Barrett's
esophagus with undulating squamo-columnar junction. (B) Short-
segment Barrett's esophagus with circumferentially elevated squamo-
columnar junction. (C) Barrett's esophagus with a tongue-like projection.
(D) Long-segment Barrett's esophagus with a columnar island (black
arrow). (E) Long-segment Barrett's esophagus with multiple squamous

39. ● Prague classification
Gastroesophageal Junction
In the following illustration, the circumferential segment (C) is 3 cm and the tongue an additional 2 cm,
so that M is 5 cm (3 cm circumferential + 2 cm tongue = 5 cm maximum Barrett’s extent, M). The
length of the Barrett’s is thus C3M5. A short Barrett’s segment only forming a 1-cm tongue is reported
as C0M1. A circular Barrett’s that is 2 cm long without tongues — i.e., with a relatively straight proximal
boundary —is reported as C2M2.

40. Common anatomical landmarks

42. References
● https://aos.amegroups.com/article/view/4946/html
● https://aos.amegroups.com/post/view/1550051583