Advancing the Endoscope

A clear luminal view is often difficult to obtain initially, particularly if the patient cannot retain the insufflated air. It is helpful, therefore, to mentally picture the course of the gastric lumen and the endoscope maneuvers that will have to be performed (Fig. 2.26).

Fig. 2.25 Entering the stomach a Pool of fluid on the greater curvature. Typical view upon entering the stomach (left side of image: string of mucus)

Fig. 2.25 Entering the stomach a Pool of fluid on the greater curvature. Typical view upon entering the stomach (left side of image: string of mucus)

b View after suctioning the fluid

Fig. 2.26 Route of the endoscope passage through the stomach.

Notice that the initial view depends on the rotational position of the endoscope

1. Advancing toward the gastric body. The instrument tip is angled slightly forward and toward the lesser curve, and the shaft is rotated slightly to the left.

2. The endoscope is straightened, advanced, and rotated slightly to the right (clockwise).

3. The endoscope is advanced with the tip angled slightly upward, passing below the ridgelike angulus.

4. The endoscope is advanced, straightened, and rotated slightly to the right.

5. The pylorus is centered in the field of view, and the endoscope is advanced toward it.

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