Views Fundus Body Junction and Gastric Body

- Fig. 2.27 View of the fundus-body junction

- Fig. 2.27 View of the fundus-body junction

View 1

The endoscope tip is straight upon entering the stomach. The gastric body is visible at the 9-o'clock position in the distant part of the field. The initial part of the fluid pool that is usually seen in the fundus is visible at the 3-o'clock position. The lesser curvature is in the 12-o'clock position, and the greater curvature is at the 6-o'clock position. As the endoscope is advanced further and air is added, the in

strument tip usually must be rotated slightly to the left and simultaneously raised by turning the inner wheel toward the endoscopist. This maneuver directs the endoscope tip toward the lesser curvature, and rotating the shaft to the left directs the scope anteriorly where most of the gastric body is located. At this stage the tip has reached the central portion of the gastric body (view 2).

- Fig. 2.28 Midbodyregionofthestomach

- Fig. 2.28 Midbodyregionofthestomach

View2

This view displays the more or less constricted lumen of the gastric body, which exhibits a prominent pattern of mucosal folds. The lumen curves out of view in the background. This view is similar to looking into a horn: You look from the base of the horn toward the tip, which is located at the end of a gentle sweep at upper right and cannot be seen. Vision is often less than optimal at this stage because the gastric body is mostly deflated, but the

luminal view should be adequate for further insertion. The endoscope is now straightened somewhat, advanced along the luminal axis, and rotated slightly to the right (clockwise), and the instrument tip is angled slightly upward again. With adequate air insufflation, the junction of the gastric body and antrum comes into view as the endoscope is advanced further (view 3).

- Fig. 2.29 View into the body-antrum junction

- Fig. 2.29 View into the body-antrum junction

View 3

The hornlike shape of the body-antrum junctional region is clearly appreciated in this view. The ridge of the angulus on the lesser curvature, located at the 12-o'clock position, restricts vision into the more distant antrum. Opposite the angulus, at the 6-o'clock position, are the diminishing rugal

folds of the gastric body. The anterior wall of the stomach is at the 9-o'clock position, the posterior wall is at the 3-o'clock position. The instrument is slowly advanced with the tip raised, not rotating the shaft, until the tip passes beneath the angulus and into the antrum (view 4).

- Fig. 2.30 View into the antrum

- Fig. 2.30 View into the antrum

View 4

The instrument is now at the center of the antrum. Peristaltic waves sweep past the instrument tip, traveling down the antrum toward the pylorus. The presence of these waves, which are highly variable in their frequency, constantly alters the appearance of the antrum. The en

doscope is advanced slowly. The pylorus is visualized by rotating the endoscope slightly to the right, which advances the tip posteriorly. Now the tip is advanced slowly toward the pylorus, accompanied by a slight straightening maneuver. The pylorus is centered in the image (view 5).

- Fig. 2.31Viewofthepylorus

- Fig. 2.31Viewofthepylorus

View5

The pylorus usually appears as a small orifice whose appearance is constantly changing due to antral peristalsis. The size of the opening is variable, ranging from punctate to gaping. The endoscope is advanced slowly, timing the advance to coincide with peristaltic waves. At this time the endoscope may form a redundant loop along the greater curvature and antrum. Thus, as the endoscope is pushed forward, the shaft bows into the antrum without advancing the instrument tip (see p. 42).

At this point the tip of the endoscope should be stationed directly in front of the pylorus (view 6).

- Fig. 2.32Views:Pylorus

- Fig. 2.32Views:Pylorus

Gaping Pylorus

View6

In this view the pylorus has opened following a peristaltic wave. Intubating the pylorus is usually difficult for the novice, who should try to center the orifice and keep withdrawing and advancing the instrument. The help of an experienced assistant who knows just when to advance the instrument is critical in this situation. After passing through the pylorus, the endoscope tip is in the duodenal bulb (Fig. 2.39).

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