Gastroenterology

GASTROENTEROLOGY

,PATIENT REQUIRING ENDOSCOPIC PROCEDURES
HISTORY OF GI ENDOSCOPY
Timeline




1. Rectal speculum found in Pompei
2. In 1868, rigid objects
3. Fiber optics – optics and the camera are allowed to see inside but it is still rigid
4. In 1961, flexible fiber-optic was invented
5. Finally, flexible endoscopy – screen + box + flexible endoscope + water pump to
clean + insuLlator attached to the aspirator
6. Double balloon enteroscope – to perform enteroscopy -> scoping the small
bowel (4-5m)
7. Capsule-endoscopy – patient swallow a pill containing a camera inside
8. High definition white light endoscopy – to ee clearly the pattern of the glands
and, with magnification (from 80 to 150 times) we are able to see small running
vessels
9. Artificial intelligence – used in the detection of as many lesions as possible
during colonoscopy

,Structure of the endoscope

Components

• A light – inside it is totally black
• A camera
• Air pressure – inside all organs are
collapsed
• A scene outside
• A channel that is part of the scope
– possibly a needle for biopsy
• A processor
Types of flexible endoscopes

• Gastroscope
o Used to: esophagogastroduodenoscopy
o Passed: trans orally
o Path: mouth, esophagus, stomach, 2nd portion
of the duodenum
o Components: forward viewing optics (in the
duodenoscope you have the side-viewing optic
to allow for lateral views)
o Range of caliber: 5 to 15m
§ Smallest: pediatrics or transanal
procedures
§ Largest: therapeutic gastroscope
o Working length: 110cm
• Colonoscope
o Used to: colonoscopy
o Passed: per rectum
o Path: rectum to the cecum and/or terminal ileum
o Component: forward-looking optics; video camera
lens, irrigation channel, light, instrument channel
o Range of caliber: 11-20mm
§ 11mm: pediatrics
o Working length: 160cm
• Duodenoscope
o Used to: endoscopic retrograde cholangipancreatography
§ Enters the biliary tree or examines the medial wall fo the
duodenum
o Passed: transorally
o Path: enters the biliary tree and the duodenum, the CBD and the PD

, o Components: side-viewing optics;
endoscopy + fluoroscopy; camera is o the
lateral side to allow the viewing of the
papilla
o Range of caliber: 2-4.2 mm
§ Mother baby scope: goes inside
the channel and inside it we have
another channel that allows to
perform biopsies
o Working length: 120cm
• Enteroscope
o Used to: small intestinal endoscopy
o Passed: orally to acces the upper SB or
transanally to access the distal SB
o Path
o Components: one/two baloons; forward-
viewing optics; (not always) over tube with
balloon assist devices to anchro the scopes
o Working length: 220cm
• Video capsule endoscopy (VCE)
o Used to: small intestinal luminal imaging
o Components: wireless capsule with one/tw
vide camera (performs 2-4 pictures sent to a
recording device that is worn by the patient)
• Echoendoscope (EUS)
o Used to: endosonography
o Components: video-endoscope + US probe –
distal end: US transmitter
§ Radial echoendoscope – only see for
diagnostic purposes, with forward-
viewing optics + 360° US view or
oblique viewing optics with 160° US
view
§ Linear echoendoscope – can take
biopsies (FNA or FNB)
• FNA or FNB only for an reati
massess for suspicion of a
pancreatic head tumor
• FNA or FNB + stent application when the mass is
compressing the PD or CBD causing jaundice