Passing the Endoscope

The endoscope tip often passes swiftly into the duodenal bulb due to the looped position of the instrument shaft along the greater curve and antrum. When the pylorus opens in this situa-t5 tion, the endoscope slips quickly into the bulb (Fig. 2.39). Usu-

E ally the bulb is inspected during instrument withdrawal, but

"5 often it can be adequately inspected during insertion. In con-

§ trast to the stomach, it is difficult to become oriented in the bul-

2 bar and proximal duodenum due to the looped position of the

"a endoscope and the various tip deflections that are used.

ra at ct ¿¿¿l Usually a small pool of fluid is seen within the r. ... . . .. . . „ , cc, ... .

•= <?2fe , , , , ,, , , , , „„ , „ Fig. 2.64 View into the duodenal bulb. A small pool of fluid is visible

_§ duodenal bulb, located between the 11- and 1- . ■ i ^ ,

■fi , , , at approximately the 11-o'clock position cu o'clock positions in the endoscopic view (Fig. 2.64). This e fluid collects at the most dependent site in the bulb and

.2 thus provides a useful landmark when it is known that the

¡2 patient is in left lateral decubitus. The true orientation of

1 the organs is shown in Figure 2.65 a. The image is dis-

£ played upside down due to the looped position of the en doscope. The endoscopist's perspective is shown in Figure 2.65 b.

- Fig.2.65 Endoscopy of the duodenal bulb ded = descending duodenum db = duodenal bulb e = esophagus s = stomach ded db ded = descending duodenum db = duodenal bulb e = esophagus s = stomach ded db e

a Anatomy of duodenal bulb endoscopy, viewed from below in true orientation. The patient is lying on the left side. The duodenal bulb lies above the stomach, and some fluid collects at the most dependent site in the bulb

b The endoscopic perspective in this situation. Because the instrument shaft forms a U-shaped loop, the image is upside-down. The fluid pool appears in the upper part of the image, at approximately the 11-o'clock position b The endoscopic perspective in this situation. Because the instrument shaft forms a U-shaped loop, the image is upside-down. The fluid pool appears in the upper part of the image, at approximately the 11-o'clock position

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