General

Indications and Contraindications ... 2

Risks and Complications: Cardiac and Pulmonary ... 3 Local Anesthesia ... 3 Sedation and Analgesia ... 3 Cardiac Complications . . . 3 Respiratory Complications . . . 3

Risks and Complications: Gastrointestinal ... 4 Perforation and Bleeding ... 4 Infection ... 4

Endoscopy Suite: Facilities and Staff ... 5 Procedure Room ... 5 Staff ... 5

Endoscopy Suite: Endoscope ... 6

Endoscopy Suite: Accessories ... 7 Endoscopic Accessories ... 7 Emergency Equipment ... 7 Documentation of Findings . . . 7

Preparations for Endoscopy: Informed Consent ... 8 Disclosure and Informed Consent ... 8

Preparations for Endoscopy: Medications (1) ... 9 Premedication and Medications Used During the Procedure ... 9

Preparations for Endoscopy: Medications (2) ... 10

Checklists Before, During, and After the Examination . . . 11

Diagnosis and Treatment of Complications (1) ... 12 Complications During the Examination . . . 12

Diagnosis and Treatment of Complications (2) . . . 13

Diagnosis and Treatment of Complications (3) ... 14 Complications Immediately After the Examination or After a Complaint-Free Interval . . . 14

Diagnosis and Treatment of Complications (4) ... 15

Diagnosis and Treatment of Complications (5) . . . 16

Endoscopic Technique: Steps in Learning . . . 17 Learning the Examination Technique . . . 17 Handling the Endoscope . . . 17

Endoscopic Technique: Maneuvering the Scope . . . 18

Endoscopic Technique: Functions . . . 19

2 Examination Technique and Normal Findings ...

Inserting the Endoscope Basic Rules . . . 22

Blind Insertion ... 23

With Visual Control ... 23

Passage through the Upper Esophageal Sphincter ... 23

Direct-Vision Insertion ... 24 Problems ... 24

Direct-Vision Insertion: Four Phases ... 25

Upper Esophageal Sphincter ... 26 Anatomy ... 26 Physiology ... 26

Cervical Esophagus ... 27 Anatomy ... 27

Middle Esophageal Constriction ... 28 Anatomy ... 28

Inspecting the Middle Esophageal Constriction ... 29

Retrocardiac Esophagus ... 30 Anatomy ... 30

Distal Esophagus and Lower Esophageal Constriction ... 31 Anatomy ... 31

Gastroesophageal Junction . . . 32 Anatomy . . . 32 Physiology . . . 32 Closure Mechanisms . . . 32

Lower Esophageal Sphincter and Diaphragmatic Hiatus . . . 33 Anatomy . . . 33

Swallowing and Esophageal Motility . . . 35 Physiology ... 35

Terminology of Esophageal Motility ... 35

Examining the Stomach During Insertion . . . 36 Technical Aspects . . . 36 Advancing the Endoscope . . . 36

Views: Fundus-Body Junction and Gastric Body ... 37

Views: Body-Antrum Junction and Antrum ... 38

Body-Antrum Junction and Antrum Details ... 41

Antral Region ... 42

Antral Peristalsis ... 43

Retroflexion Maneuver . . . 44

Components of Retroflexion ... 44

Retroflexion in the Stomach ... 45 Maneuvering the Endoscope ... 45

Inspection of the Fundus ... 46

Maneuvering the Endoscope ... 46

Inspection of the Cardia ... 47

Maneuvering the Endoscope ... 47

Relations of the Stomach: Abdominal Wall ... 48 Anatomy ... 48

Identifying the Abdominal Wall ... 48

Relations of the Stomach: Pancreas ... 49 Impression from the Pancreas ... 49

Relations of the Stomach: Liver ... 50

Impression from the Inferior Hepatic Border ... 50

Relations of the Stomach: Heart and Spleen ... 51 Cardiac Notch, Impressions from the Heart and Spleen ... 51

Passage into the Duodenal Bulb . . . 52 Passing the Endoscope ... 52

Passage into the Descending Duodenum . . . 53 Maneuvering the Endoscope ... 53

Views: Bulbar and Proximal Duodenum . . . 54

Views: Descending Duodenum and Superior

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