endoscopy
Endoscopy is a diagnostic and therapeutic medical procedure that involves the insertion of a flexible or rigid tube, known as an endoscope, into natural orifices or small incisions to visualize the interior of hollow organs or body cavities. This minimally invasive technique provides direct optical inspection, facilitating precise diagnosis and intervention.
Instrumentation and Principle: An endoscope is equipped with a light source, a high-resolution camera, and often working channels for the introduction of various instruments. Images are transmitted to a video monitor, providing a magnified and illuminated view of the target anatomy. Modern endoscopes incorporate advanced imaging modalities, such as narrow-band imaging (NBI) or chromoendoscopy, to enhance mucosal detail and detect subtle lesions.
Procedural Variations and Applications: Endoscopic procedures are diverse, tailored to the specific anatomical region of interest. Common types include:
- Gastrointestinal Endoscopy:
- Esophagogastroduodenoscopy (EGD): Examination of the esophagus, stomach, and duodenum, commonly used for evaluation of dysphagia, dyspepsia, gastrointestinal bleeding, and for biopsy or polyp removal.
- Colonoscopy: Visualization of the entire colon and rectum, serving as a primary screening tool for colorectal cancer, and for polypectomy or control of lower GI bleeding.
- Flexible Sigmoidoscopy: Examination of the rectum and distal colon.
- Endoscopic Retrograde Cholangiopancreatography (ERCP): Combines endoscopy with fluoroscopy to diagnose and treat conditions of the bile and pancreatic ducts, such as gallstones or strictures.
- Endoscopic Ultrasound (EUS): Integrates ultrasound technology with an endoscope, providing cross-sectional imaging of the gastrointestinal wall and adjacent structures, useful for staging tumors and fine needle aspiration (FNA) biopsies.
- Capsule Endoscopy: Patient swallows a disposable capsule containing a camera for non-invasive imaging of the small intestine.
- Respiratory Endoscopy:
- Bronchoscopy: Examination of the tracheobronchial tree for diagnostic purposes (e.g., biopsy of lung lesions, bronchoalveolar lavage) or therapeutic interventions (e.g., foreign body removal, stent placement).
- Urological Endoscopy:
- Cystoscopy: Visualization of the bladder and urethra.
- Ureteroscopy: Examination of the ureters and renal pelvis.
- Gynecological Endoscopy:
- Hysteroscopy: Direct visualization of the uterine cavity.
- Orthopedic Endoscopy:
- Arthroscopy: Inspection and treatment of joint pathologies.
Techniques and Therapeutic Capabilities: Beyond visualization and diagnosis, endoscopy facilitates a wide range of therapeutic interventions. These include:
- Biopsy: Tissue sampling for histopathological analysis.
- Polypectomy: Endoscopic removal of polyps.
- Hemostasis: Management of bleeding using various modalities (e.g., injection therapy, electrocautery, clip application).
- Dilation and Stenting: Widening of stenotic areas and placement of stents to maintain lumen patency.
- Foreign Body Retrieval: Removal of ingested or aspirated objects.
- Endoscopic Mucosal Resection (EMR) and Endoscopic Submucosal Dissection (ESD): Techniques for en bloc resection of superficial early-stage neoplastic lesions.
- Radiofrequency Ablation (RFA): Treatment of dysplastic or early neoplastic lesions, such as Barrett's esophagus.
Patient Preparation and Post-Procedure Care: Preparation protocols vary by endoscopic type, often including fasting and/or bowel preparation. Procedures are typically performed under conscious sedation or general anesthesia, ensuring patient comfort and cooperation. Post-procedure, patients are monitored for recovery from sedation and potential complications, such as perforation, bleeding, or infection.
Advantages: Endoscopy offers numerous benefits over traditional open surgical approaches, including reduced invasiveness, lower risk of complications, decreased postoperative pain, shorter recovery times, and avoidance of external scarring. These advantages contribute significantly to enhanced patient comfort and expedited return to daily activities.
PEG and Esophageal Stent Insertion for Advanced...
PEG placement and esophageal stent insertion in a 78-year-old patient with advanced pulmonary neoplasia and dysphagia. Procedure Steps: PEG Placement: 1. Perform transillumination to identify the appropriate...
ERCP: SEMS in Advanced Pancreatic Cancer
A 70-year-old patient diagnosed with locally advanced pancreatic head neoplasia involving the duodenum, as observed on a CT scan. The patient presents with abnormal liver function tests and jaundice....
Pancreatic Stent Placement
Placement of a plastic pancreatic stent for preventionof post ERCP pancreatitis.
Endoscopic View: Large Hiatal Hernia
The endoscopic view of a hiatal hernia shows the herniation of the stomach through the esophageal hiatus into the mediastinum. This view is crucial for diagnosing conditions like severe gastroesophageal...
An Anastomotic Recto-colic Leak
An anastomotic recto-colic leakTwo previous endoscopies were unable to detect the leak. The use of a cap, cannula, and guidewire enables accurate localization of the leak.
Endoscopic Resection of Microadenoma in Acromegaly:...
45 yo female - acromegalic features and DMII. High IGF-1 and GH. Surgical point: Appropriate exposure of the cavernous sinus in cases of microadenomas that have reached the cavernous sinus is a crucial...
P-EMR for a Transverse Colon NG-LST Measuring...
P-EMR for a transverse colon NG-LST measuring 20 x 40 mm Avoid biopsy if no suspicious area is detected. A 76-year-old patient presented with three LSTs located in the cecum, right colon, and transverse...
Hardly Visible Flat Colonic Lesion
Clinical case presentation: how many of that lesions are missed - "That is the question". The case presents hardly visible flat colonic lesion Paris 0-IIb flat adenoma pretty easy to miss out.
ESD of Neighbouring Lesions Including LSTG
Endoscopic video case: patient post right colectomy for LSTG adenoma was found to have a few more lesions in the remnant colon. This time was not encouraged by the surgeon to have the rest of his colon...
Post EVL - Rubber Band Ligation - a Picture of...
Post EVL - rubber band ligation - a picture of esophageal healing process and complication. Patient 7 days after endoscopic variceal ligation presenting with upper tract bleeding - rubber bands in place,...
Esophageal Varices Actively Bleeding - Endoscopic...
A case of a young gentleman presenting with actively bleeding esophageal varices. Venous pulsatile blood flow is clearly visible. Haemorrhage as a first presentation of portal hypertension due to...
Large Lesion Colonic pEMR in Unstable Scope Position
A case of patient with serrated polyposis syndrome. In addtion to SSP a large lesion of simingly other origin was found. Patient referred for endoscopic removal. This large polyp location in...
Eesophageal Varices Bleeding
A thorough endoscopic examination of the esophagus is essential for diagnosing varices and identifying bleeding sources. A cirrhotic patient with hematemesis referred for endoscopic therapy. After a careful...
Underwater EMR
Underwater Mucosectomy (UM) is an advanced endoscopic technique used to remove mucosal lesions in the colon or rectum without the need for submucosal injection. It is a variation of Endoscopic Mucosal...