Techniques of Upper Endoscopy
An increasingly central component to the practice of general surgery is flexible endoscopy. At least half of the practicing surgeons in the USA depend on basic upper and lower endoscopy for a substantial portion of their practice. In fact, outside of most urban centers, the burden of providing endoscopy falls entirely on the general surgeon. Many common surgical disease treatments have already shifted, or are rapidly shifting towards less invasive approaches which increasingly include interventional flexible endoscopic procedures. A brief look in the recent past underlines this fact. Common bile duct exploration, pancreatic pseudocyst drainage, colectomy for benign or early neoplasia, and esophagectomy for Barrett’s disease are but a few of the conditions that are now treated endoscopically instead of surgically. As this trend continues, surgeons unskilled in flexible endoscopy will find themselves increasingly cut out of the treatment of these diseases.
KeywordsPercutaneous Endoscopic Gastrostomy Esophageal Mucosa Eosinophilic Esophagitis Common Bile Duct Exploration Esophageal Intubation
Asking the patient to swallow often opens the cricopharyngeal sphincter briefly allowing easy passage of the scope (MOV 4770 kb)
Hiatal hernia size (distance from Z-line to crus) is roughly measured from this point (MOV 4553 kb)
The lesser curve should be “hugged” by the scope as one advances towards this landmark which leads the endoscopist towards the antrum and pylorus (MOV 7770 kb)
Hiatal hernias are easily seen in this view and it is critical in evaluating fundoplication integrity (MOV 6746 kb)
The duodenum can be carefully inspected during slow withdrawal (MOV 10621 kb)