Basic Rules

Several methods can be used to insert the endoscope. None of these methods has major advantages over the others, but certain rules need to be followed (Fig. 2.1). Because insertion of the endoscope is the most unpleasant part of the examination for most patients, it should be carried out in a calm, assured manner. The patient lies on the left side with the chin tucked against the chest. The bite guard may be placed securely between the teeth at this time, or it may be fitted over the instrument shaft before sliding the endoscope carefully into the mouth. In the latter case, the bite guard is not placed until the endoscope has entered the upper esophagus. If difficulties arise, especially due to interference from the tongue, the fingers can be used to assist endoscope insertion. In rare cases the patient may have difficulty tolerating the procedure in left lateral decubitus, and the endoscopist may attempt to pass the scope with the patient sitting up. This should be reserved for exceptional cases, however.

3 CT

- Fig.2.1 Inserting the endoscope

- Fig.2.1 Inserting the endoscope

a The patient is in the left lateral position

b The chin is tucked against the chest

c The bite guard is placed a The patient is in the left lateral position b The chin is tucked against the chest c The bite guard is placed

d The endoscope tip is preangled and inserted through the bite guard

e Once inside the mouth, the slightly angled endoscope tip is rotated into the mesopharynx and advanced

f The endoscope is advanced toward the hypopharynx d The endoscope tip is preangled and inserted through the bite guard

Alternative method e Once inside the mouth, the slightly angled endoscope tip is rotated into the mesopharynx and advanced f The endoscope is advanced toward the hypopharynx

g The bite guard is fitted over the instrument shaft
h Insertion is aided by guiding the endoscope tip with the index and middle fingers
i After the endoscope is in the hypopharynx, the bite guard is slid into place

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