Stuttgart New York

Library of Congress Cataloging-in-Publication Data is available from the publisher

This book is an authorized translation of the German edition published and copyrighted 2003 by Georg Thieme Verlag, Stuttgart, Germany. Title of the German edition: Der Gastroskopie-Trainer: Schritt-für-Schritt-Anleitungen für die Ösophago-, Gastro- und Duodenoskopie

Translator: Terry C Telger, Fort Worth, TX, USA

Important note: Medicine is an ever-changing science undergoing continual development. Research and clinical experience are continually expanding our knowledge, in particular our knowledge of proper treatment and drug therapy. Insofar as this book mentions any dosage or application, readers may rest assured that the authors, editors, and publishers have made every effort to ensure that such references are in accordance with the state of knowledge at the time of production of the book.

Nevertheless, this does not involve, imply, or express any guarantee or responsibility on the part of the publishers in respect to any dosage instructions and forms of applications stated in the book. Every user is requested to examine carefully the manufacturers' leaflets accompanying each drug and to check, if necessary in consultation with a physician or specialist, whether the dosage schedules mentioned therein or the contraindications stated by the manufacturers differ from the statements made in the present book. Such examination is particularly important with drugs that are either rarely used or have been newly released on the market. Every dosage schedule or every form of application used is entirely at the user's own risk and responsibility. The authors and publishers request every user to report to the publishers any discrepancies or inaccuracies noticed.

Some of the product names, patents, and registered designs referred to in this book are in fact registered trademarks or proprietary names even though specific reference to this fact is not always made in the text. Therefore, the appearance of a name without designation as proprietary is not to be construed as a representation by the publisher that it is in the public domain.

© 2004 Georg Thieme Verlag,

Rüdigerstrasse 14, 70469 Stuttgart, Germany

Thieme New York, 333 Seventh Avenue,

New York, NY 10001 USA

This book, including all parts thereof, is legally protected by copyright. Any use, exploitation, or commercialization outside the narrow limits set by copyright legislation, without the publisher's consent, is illegal and liable to prosecution. This applies in particular to photostat reproduction, copying, mimeographing, preparation of microfilms, and electronic data processing and storage.

Typesetting by primustype Hurler, Notzingen Printed in Germany by Grammlich, Pliezhausen

Attempts to look into human body orifices and body cavities date back to antiquity. Most of these efforts met with little success because of poor illumination. A breakthrough came in 1806 when Philip Bozzini introduced his Lichtleiter ("light conductor"), which supplied at least a theoretical solution to the problem. Bozzini was the first to envision the future application of endoscopes in urology, gynecology, and gastroenterology and the eventual development of laparoscopy.

Adolf Kussmaul introduced the rigid gastroscope in the 1890s. The gastroscopes used during the first half of the 20th century were semirigid devices in which lens systems transmitted the image to an eyepiece. A major advance came in the mid-20th century, when Basil Hirschowitz developed a flexible fiberoptic endoscope. But even this technology appears to have been superseded by the development of video endoscopy and, more recently, by wireless capsule endoscopy.

As endoscopy has evolved, the instruments have become more flexible and their outer diameters smaller, making the examination much easier for both the endoscopist and the patient. Today, upper gastrointestinal endoscopy is the most rewarding procedure for investigating complaints of the upper gastrointestinal tract. Visual inspection, specimen collection, and any necessary interventions can be carried out in the same sitting. Upper gastrointestinal endoscopy is safe and easy to perform for experienced endoscopists.

The quality of the examination depends upon the interplay between the endoscopic technique and the interpretation of the images. Anyone who is learning endoscopy is bound to encounter technical difficulties at first. For this reason, we have provided ample didactic information to supplement the atlas portions of this book.

Endoscopic interventional procedures have been practiced for more than 30 years. The range of endoscopic treatment options is constantly expanding, and examiners are often expected to perform these interventions in the early phase of their endo-scopic training. Established therapeutic procedures are described in some detail, therefore.

We hope to provide our readers with an easy-to-use, comprehensive introduction to the method and its capabilities, and we wish them much success and satisfaction in the practice of gastrointestinal endoscopy.

Braunschweig and Berlin, spring 2004

Berthold Block Guido Schachschal Hartmut Schmidt

We wish to recognize all those who contributed to the success of this book. We thank the following colleagues for providing en-doscopic images:

Dr. med. Dirk Bandorski, Fulda Medical Center, Medical Clinic II, Pacelliallee 4, 36043 Fulda.

Dr. med. Christian Bömecke, Agnes Karl Hospital, Hildesheimer Strasse 158, 30880 Hanover-Laatzen.

Dr. med. Thomas Koch, Medical Clinic I, St. Walburga Hospital, Schederweg 12, 59872 Meschede. (

Dr. med. Werner Schmidtbaur, Augsburg Medical Center, Medical Clinic III, Stenglinstrasse 2, 68156 Augsburg.

We are grateful to Mr. Horst Wesche, of the German Photographic Society in Hanover, for kindly providing the images pertaining to duodenal tube placement.

We thank Mrs. Stephanie Gay and Mr. Bert Sender of Bremen for turning our rough drawings into superb illustrations. Some of the graphics were based on drawings by Mr. Michael Gradias of Wolfenbüttel (originally done for the Teaching Atlas of Gastro-scopy. Stuttgart: Thieme; 1997).

We thank the excellent staff at our endoscopy unit at the Charité Hospital for their help and patience in obtaining the en-doscopic images: Mrs. Ingrid Olerich, Mrs. Silvia Meinert, Mrs. Dagmar Nitschke, Mrs. Martina Linser, Mrs. Marion Doss, Mrs. Marion Strelow, Mrs. Grit Gartmann, Mrs. Annette Klameth, and Mr. Frank Maltzahn.

It is one thing to write text and obtain endoscopic images, but it is quite another to turn them into a book. We are grateful to the staff at Thieme Medical Publishers for presenting our text and endoscopic images in such an exquisite form. We thank Dr. Antje Schönplug and Mrs. Marion Holzer for their tireless efforts. We also thank Dr. Markus Becker, who contributed so much to the success of this book during all phases of its planning and production.

Berthold Block Guido Schachschal Hartmut Schmidt


aminolevulinic acid


lower esophageal sphincter




mucosa-associated lymphoid tissue


adult respiratory distress syndrome


nothing by mouth




nonsteroidal anti-inflammatory drugs


computed tomography


polymerase chain reaction




percutaneous endoscopic gastrostomy




percutaneous endoscopic jejunostomy


ear, nose, and throat


proton pump inhibitors


gastric antral venous ectasia


transjugular intrahepatic portosystemic shunting


gastrointestinal (only in "upper GI endoscopy")




herpes simplex virus


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