PEG Placement Principle Indications and Contraindications

PEG provides a rapid, simple method for long-term enteral feeding. Although the method can generally be used without complications, there are still some significant risks that should be kept in mind. PEG placement is a technically simple procedure (Figs. 4.32, 4.33). A cannula is passed through the abdominal wall, and a guide suture is threaded into the stomach through the cannula. It is retrieved endoscopi-cally, withdrawn through the mouth, and used to pull the PEG tube down the esophagus and...

Grade IIV Reflux Esophagitis

Pictures Reflux Esophagitis

The inflammatory lesions of reflux esophagitis are currently graded according to the Savary-Miller classification, which is summarized in Table 3.4. Grades I-III. Grades I-III Fig. 3.25 reflect a more or less pronounced acute attack. These grades may be complicated by superficial bleeding, but some cases initially resolve without sequelae. Grade IV. Grade IV Fig. 3.26 represents the chronic, complicated stage of reflux esophagitis, which is subject to its own dynamic. The most serious...

Overview of Pathological Findings in the Duodenum

Bulbitis Duodeni

Table 2.26 Pathological findings in the duodenum Table 2.26 Pathological findings in the duodenum Fig. 3.136 Polypoid lesions in the duodenal bulb Fig. 3.136 Polypoid lesions in the duodenal bulb Fig. 3.139 Inflammation and necrosis in the duodenum of a patient with pancreatitis Fig. 3.139 Inflammation and necrosis in the duodenum of a patient with pancreatitis Duodenal ulcer is an epithelial defect in the bulbar or descending duodenum that penetrates the muscularis mucosae and extends into the...

The Operated Stomach Endoscopically Identifiable Lesions and Diseases

Roux Anastomose

It is very common to find erythematous and sometimes bile-tinged mucosa just proximal to the stoma in the operated stomach. Histologically, inflammatory mucosal changes are found in 60-90 of cases. It is likely that the reflux of bile and alkaline pancreatic juice has causal significance. The degree of macroscopic and histological changes does not correlate with the severity of the complaints, and many patients are asymptomatic. The endoscopic picture is characterized by edema, erythema, and...

Components of Retroflexion

Stomach Retroflexion

Since the entire upper gastrointestinal tract is inspected and evaluated with a forward-viewing endoscope, retroflexion is necessary to obtain a complete view of the cardia and fundus. The angulus and body are also examined in retroflexion Figs. 2.43, 2.44 . The retroflexion maneuver consists of the following components The large inner control wheel moves the instrument tip in the plane of the wheel - Turning the wheel backward counterclockwise deflects the endoscope tip forward and upward into...