DR.R.

DURAI MS
ASSISSTANT PROFESSOR
DEPARTMENT OF GENERAL SURGERY
MGMCRI
 Endoscopy is a nonsurgical procedure used to examine a
person's Gastrointestinal tract using an endoscope, a flexible
tube with a light and camera attached to it
 1958 Development of fibreoptic gastroscope
 1968 Endoscopic retrograde pancreatography
 1969 Colonoscopic polypectomy
 1970 Endoscopic retrograde cholangiography
 1974 Endoscopic sphincterotomy (with bile duct stone extraction)
 1979 Percutaneous endoscopic gastrostomy
 1980 Endoscopic injection sclerotherapy
 1980 Endoscopic ultrasonography
 1983 Electronic (charge coupled device) endoscope
 1985 Endoscopic control of upper gastrointestinal bleeding
 1990 Endoscopic variceal ligation
 1996 Introduction of self-expanding metal stents
 2008 Endomicroscopy delivers histological mucosal definition
 UPPER GI ENDOSCOPY
 ENTEROSCOPY
 COLONOSCOPY
ENDOSNCOPY PRINCIPLE
 Endoscopy minimally invasive
diagnostic medical procedure
used to evaluate interior surface
of an organ.

 Endoscope may have rigid or

flexible tube inserted into body. It
has ability to looking inside the
body using a variety of very small
cameras attached to flexible or
rigid tube. It facilitates direct
viewing the interior of an organ is
often very helpful in determining
the cause of a problem.
ENDOSCOPY
PRINCIPLE(CONTD…)

 An endoscope is a flexible tube

equipped with lenses and a light
source. Illumination is done by the help
of a number of optical fibers.

 Video endoscopy performed by

attaching in microchip camera at the
insertion tube, setup image is viewed on
a video monitor.
Distal Tip of Insertion
Tube
 ENDOSCOPY PIC
FIBERSCOPES VIDEO
ENDOSCOPE
 Superior to Radiology
 Except for motility disorders

 Take Biopsies
 Explain cause of pain
 Reflux Oesophagitis
 Ulcer disease
 Oesophagus to jejunum
 Malignancy

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 Haemorrahage
 Injection
 Clips

 Removal of foreign bodies

 Dilation of strictures
 Stenting
 Feeding – PEG
 Percutaneous Endoscopic Gastrostomy

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 In the pyloric region
 1st part of the duodenum
 The gastric ulcer

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 Small bowel pathologies
 Angiodysplasia
 Meckel’s diverticula
 NSAID related enteropathy
 Benign or malignant tumour
 Push enteroscopy
 Double balloon enteroscopy (DBE)
 Single balloon enteroscopy (SBE)
 Spiral enteroscopy

 Capsule endoscopy
 Indications:
 GI bleeding of obscure origin
 Chronic diarrhoea
 Malabsorptive syndrome
 Chronic abdominal pain

 Therapeutic application:
 Foreign body removal
 Mucosal resection
 Insertion of SEMS
 Dilatation of stricture in Crohn’s disease
 ERCP after Billroth II or Roux-en-Y reconstruction or
after bariatric surgery
 Described by Tada in 1977
 Sonde enteroscopy
 Working length of 250-400cm
 Propelled by small bowel peristalsis
 Lack of working channel and prolonged examination time
 Performed with a dedicated enteroscope with an overtube
 Method:
 Overtube loaded onto the enteroscope
 Enteroscope enter the proximal jejunum
 Overtube pushed into the 3rd part of duodenum and held by
assistant
 Enteroscope proceed to advance into the jejunum

 Depth of insertion: 40 to 100cm past ligament of Treitz

 In contrast to DBE, balloon is not
attached to the tip of the
enteroscope
 Stable positioning in the small
bowel is achieved during
withdrawal of the scope by angling
the tip of the endoscope
 Described by Dr Akerman
 First performed in 2006
 Applies the mechanical advantage of a screw to convert
rotational force into linear one
 Currently more than 2000 cases have been performed
worldwide
 Device:
 Discovery SB overtube
 Spirus Corporation
 Overall length 118cm
 Outer diameter 14.5mm
 Accomodates endoscope <9.4mm
diameter
 Method
 Overtube is backloaded on the enteroscope
 Advanced slowly with gentle clockwise rotation of the overtube
 Spiral passes beyond the ligament of Treitz
 Spiral threads engage in the jejunum and mobile small bowel can
be rapidly pleated onto the enteroscope
 Mucosal stripping
 Pancreatitis
 Aspirations
 Bleeding
 Gastric, duodenal and jejunal perforations

 Complication rate generally <1%

CAPSULE ENDOSCOPY
 Capsule endoscopy was first used in humans in 1999.
 First publication on capsule endoscopy was published in
Nature in 2000:
Iddan G, Meron G, Glukhovsky A, Swain P. Wireless capsule
Endoscopy. Nature. 2000; 405:417.
TYPES OF ENDOSCOPIC
CAPSULES
HOW DOES CAPSULE
ENDOSCOPY WORK?
 Capsule is initially stored in a case containing a magnet that
inhibits capsule activation. Once it taken out of the case, the LEDs
start to flash and the capsule start to transmit.
 Eight aerial leads that are attached around the patient’s abdomen
collect data.
 Capsule ingested as any other capsule.

 Patient can drink clears immediately, but no solid food for 3 hours.

 Attached to the leads is the recorder and the patient should report
back if it stops recording for any reason.
 Belt and aerial should be worn for 8 hours after swallowing or until
the recorder stops recording.
 Recorder and aerials are returned, but the capsule is disposable!

 Images are downloaded and processed prior to interpretation.

GIVEN IMAGING RAPID
VIEWING SCREEN
 Direct mucosal visualisation
 Patient acceptibility
 Lack of ionising radiation

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 Cost
 Reporting time
 Impaction
 Difficult to localise the lesion
 High miss rate

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 Overview
• Colonoscopy is a procedure used to see
inside the colon and rectum.
• Colonoscopy can detect inflamed tissue,
ulcers,
and abnormal growths.
• The procedure is used to look for early
signs of colorectal cancer and can help
doctors diagnose unexplained changes in
bowel habits, abdominal pain, bleeding
from the anus, and weight loss.
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 Follow up of colorectal cancer and
polyps
 Screening of patients with a
family history of colorectal cancer
 Assessment/removal of a lesion
seen on radiological examination
 Assessment of ulcerative
colitis/Crohn’s extent and activity
 Surveillance of inflammatory
bowel disease
 Surveillance of
acromegaly/ureterosigmoidostomy
 Rectal bleeding with looser or more
frequent stools ±
 abdominal pain related to bowel
actions
 Iron deficiency anaemia (after
biochemical confirmation ±
 negative coeliac serology):
oesophagogastroduodenoscopy and
colonoscopy together
 Right iliac fossa mass if ultrasound
is suggestive of colonic origin
 Change in bowel habit associated
with fever/elevated inflammatory
response
 Chronic diarrhoea (>6 weeks) after
sigmoidoscopy/rectal
 biopsy and negative coeliac serology