Interventional Procedures and Extended Endoscopic Examination Methods 142

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Overview of Interventional Endoscopy

Upper Gastrointestinal Bleeding:

Incidence and Signs ... 145 Incidence ... 145 Causes ... 145 Symptoms ... 145

Upper Gastrointestinal Bleeding:

Primary Treatment ... 146

Hemodynamic Stabilization ... 146 Maintaining Adequate Respiration ... 146 Identify the Source of Bleeding and Stop the Bleeding ... 146

Bleeding Esophageal Varices and Fundic Varices:

Medications and Tubes ... 147 Treatment Methods ... 147 Pharmacological Therapy of Bleeding Esophageal Varices ... 147 Balloon Tamponade ... 147

Bleeding Esophageal Varices: Sclerotherapy ... 148 Endoscopic Treatments ... 148 Sclerotherapy with Polidocanol (Ethoxysclerol) ... 148

Bleeding Esophageal Varices: Banding ... 149

Sclerotherapy of Fundic Varices, TIPS, and Operative Treatment ... 150

Transjugular Intrahepatic Portosystemic Shunt (TIPS) ... 150 Operative Treatment ... 150

Bleeding Ulcers: Nonoperative Therapies ... 151 Incidence and Symptoms ... 151 Nonoperative Treatment Methods ... 151 Indications for Endoscopic Treatment ... 151

Bleeding Ulcers: Forrest Classification ... 152

Bleeding Ulcers: Pharmacological Therapy and Injection Techniques ... 153

Pharmacological Therapy of Bleeding Ulcers ... 153 Endoscopic Techniques ... 153 Injection Therapy . . . 153

Bleeding Ulcers: Hemoclip Application and Thermal Methods ... 154 Hemoclip Application ... 154 Thermal Methods ... 154

Bleeding Ulcers: Management after Primary Hemostasis and in Special Cases . . . 155

Management after Primary Hemostasis . . . 155 Hemostasis of a Mallory-Weiss Lesion ... 155 Hemostasis of a Bleeding Dieulafoy Ulcer ... 155 Hemostasis in Hemorrhagic Gastritis ... 155

Specimen Collection ... 156 Biopsy ... 156 Brush Cytology ... 156 Fluid Sampling . . . 156

Endoscopic Treatment of Precancerous Lesions and Early Carcinoma ... 157 Open Resection ... 157 Endoscopic Treatments ... 157 Polypectomy . . . 157 Endoscopic Mucosectomy . . . 157 Photodynamic Therapy . . . 157

Foreign Body Removal ... 158 Incidence and Location ... 158 Symptoms ... 158 Rules for Management . . . 158

Foreign Body Removal: Types of Objects Swallowed ... 159 Coins ... 159

Marbles ... 159 Batteries . . . 159 Pieces of Meat . . . Partial Dentures .

Needles, Toothpicks ... 159 Foreign Bodies with a Hole ... 159 Percutaneous Endoscopic Gastronomy (PEG) Bumper ... 159 Condoms Containing Narcotics ... 159

PEG Placement: Principle, Indications, and Contraindications ... 160 Principle ... 160 PEG Tubes ... 160

Alternative Methods of Tube Placement Indications ... 160 Contraindications ... 160 Informed Consent ... 160 Complications . . . 160 Preparations . . . 160 Aftercare . . . 160

Duodenal Tube: Insertion through a PEG ... 165

PEJ, Special Cases, and Complications during Tube Placement . . . 166

Removal of PEG Tube, Placement of Duodenal Tube ... 167 PEG Tube Removal ... 167 Placement of a Duodenal Tube ... 167

Duodenal Tube Placement: Technique (1) ... 168

Duodenal Tube Placement: Technique (2) ... 169

Duodenal Tube Placement: Technique (3) ... 170

Upper Gastrointestinal Stenoses, Malignant Strictures . . . 171

Causes and Sites of Occurrence . . . 171 Treatment Options . . . 171 Malignant Strictures . . . 171 Esophageal Carcinoma . . . 171 Bronchial Carcinoma . . . 171

Benign Stenoses ... 172

Peptic Esophageal Stricture . . . 172

Gastric Outlet Stricture . . . 172

Corrosive Ingestion . . . 172

Fundoplication . . . 172

Anastomotic Stenosis . . . 172

Banding and Sclerotherapy of Varices ... 172

Upper Gastrointestinal Stenoses: Dilation Methods ... 173 Bougie Dilation . . . 173 Balloon Dilation . . . 173

Upper Gastrointestinal Stenoses: Incision, Self-Expanding Stents . . . 174 Incision of Strictures ... 174 Self-Expanding Stents ... 174

Upper Gastrointestinal Stenoses: Intubation, Laser Treatment . . . 175 Intubation ... 175 Laser Treatment ... 175

Upper Gastrointestinal Stenoses: Coagulation and Botulinum Toxin . . . 176 Argon Plasma Coagulation . . . 176 Injection of Botulinum Toxin . . . 176

Chromoendoscopy: Lugol Solution ... 177 Definition and Stains . . . 177 Lugol Solution . . . 177

Chromoendoscopy: Methylene Blue . . . 178

Methylene Blue and Barrett Epithelium ... 178

Chromoendoscopy: Indigo Carmine, Uses of Vital Stains . . . 179 Indigo Carmine ... 179 Possible Uses of Vital Stains in the Upper Gastrointestinal Tract . . . 179

Fluorescent Endoscopy and Magnification Endoscopy . . . 180

Principle of Fluorescent Endoscopy ... 180 Magnification Endoscopy ... 180 Fluorescent Endoscopy with 5-ALA ... 180

Enteroscopy ... 181

Sonde Enteroscopy ... 181 Push Enteroscopy ... 181 Intraoperative Enteroscopy . . . Capsule Endoscopy ... 181

Junction Endoscopy Reflux Esophagitis

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