Endoscopy: DR Rubeena Ali SR Radiology Deptt Amth/Rlmc

ENDOSCOPY
DR RUBEENA ALI
SR
RADIOLOGY DEPTT
AMTH/RLMC
WHAT IS ENDOSCOPY???
 ENDO INSIDE
 SCOPY TO LOOK
 An endoscopy is used in medicine to look inside the body.
 The endoscopy procedure uses an endoscope to examine the
interior of a hollow organ or cavity of the body.
 Unlike many other medical imaging techniques, endoscopes are
inserted directly into the organ.
MEDICAL APPLICATIONS
 The gastrointestinal tract (GI tract): oesophagus, stomach and duodenum

(ESOPHAGOGASTRODUODENOSCOPY)
 small intestine (ENTEROSCOPY)
 large intestine/colon (COLONOSCOPY, SIGMOIDOSCOPY)
 Magnification endoscopy
 bile duct
 endoscopic retrograde cholangiopancreatography (ERCP),
DUODENOSCOPE-ASSISTED CHOLANGIOPANCREATOSCOPY,
INTRAOPERATIVE CHOLANGIOSCOPY
 rectum (RECTOSCOPY) and anus(ANOSCOPY), both also referred to as
(PROCTOSCOPY)
The respiratory tract
The nose (RHINOSCOPY)
The lower respiratory tract (BRONCHOSCOPY)
The ear (OTOSCOPE)
The urinary tract (CYSTOSCOPY)
The female reproductive system (GYNOSCOPY)
The cervix (COLPOSCOPY)
The uterus (HYSTEROSCOPY)
The fallopian tubes (FALLOPOSCOPY)
Endoscopy is used for many procedures:
 During pregnancy  Endodontic surgery
 The amnion (AMNIOSCOPY)  Maxillary sinus surgery
 The fetus (FETOSCOPY)  Apicoectomy
 Orthopedic surgery  Endoscopic endonasal surgery
 Hand surgery, such as endoscopic carpal  Endoscopic spinal surgery
tunnel release  Plastic surgery
 Knee surgery, such as anterior cruciate  PANENDOSCOPY (or triple endoscopy)
ligament reconstruction
 Combines laryngoscopy,
 Epidural space (EPIDUROSCOPY)
 esophagoscopy, and bronchoscopy
 Bursae (Bursectomy)
ENDOSCOPE
 An endoscope is a slender, flexible

tube equipped with lenses and a
light source. Illumination is done
by the help of a number of optical
fibres.
 Reflected light rays are collected
by CCD( Charge coupled device)
and electrical signals are produced,
which are fed to the video monitor
to get image.
COMPONENTS OF AN ENDOSCOPE
 a long, flexible tube,

 a fiber optic light
 a camera lens
 another channel that can be used for other medical instruments if
necessary
Video endoscopy performed by
attaching in microchip camera at the
insertion tube, setup image is viewed on
a video monitor.
 Through one channel of endoscope
water and air is conducted to wash and
dry the surgical site.
 The endoscope also has a channel
through which surgeons can
manipulate tiny instruments, such as
forceps, surgical scissors, and suction
devices.
 A variety of instruments can be fitted
to the endoscope for different
purposes.
Distal Tip of Insertion Tube
PROCEDURE
UPPER GI ENDOSCOPY
• Not to eat or drink for 8 hours

before the test.
• An IV (intravenous) line is secured
Sedation via IV injection
Heart rate, blood pressure, respiratory rate, and oxygen level
monitored during the procedure.
Patient lies on his left side on the X-ray table with head bent
forward.
Local anesthetic spray on back of throat.
Holding breath during the spray may decrease the taste.
Patient will not be able to swallow the saliva that may collect in mouth
during the procedure.
This happens because the tube is in throat. The saliva will be suctioned
from time to time.
A mouth guard will be placed in patient’s mouth.
This will keep patient from biting down on the tube. It will also protect his
teeth.
Then the tube is placed into the mouth which is then guided
down into the esophagus, stomach and duodenum.
If needed, samples of fluid or tissue can be taken at any time
during the test.
Other procedures, such as removing a blockage, may be
done while the tube is in place.
After the exam and procedures are done, the tube will be
taken out.
 After the procedure, patient will be taken to the recovery room to
be watched. Once blood pressure, pulse, and breathing are stable
and patient is awake and alert, patient is sent back to the ward or
discharged.
 Patient will not be allowed to eat or drink anything until his gag
reflex returns. This is to prevent him from choking.
 Patient may have a sore throat and pain for a few days when he
swallows. This is normal.
EXAMPLES OF THERAPEUTIC TECHNIQUES IN ENDOSCOPY.
LAPROSCOPY
 General anasthesia
 During laparoscopy, the surgeon makes an incision below umblicus, and then
inserts a small tube called a cannula. The cannula is used to inflate abdomen with
carbon dioxide gas. This gas allows to see abdominal organs more clearly.
 Once abdomen is inflated, the surgeon inserts the laparoscope through the
incision. The camera attached to the laparoscope displays the images on a screen,
allowing organs to be viewed in real time.
LAPROSCOPY
 The number and size of incisions depends upon what specific diseases surgeon is
attempting to confirm or rule out. Generally, there are one to four incisions that
are each between 1 and 2 centimeters in length. These incisions allow other
instruments to be inserted. For example, surgeon may need to use another
surgical tool to perform a biopsy.
 After the procedure is done, the instruments are removed. Incisions are then
closed with stitches or surgical tape. Bandages may be placed over the incisions.
ARTHROSCOPY
 For knee arthroscopy only two small

incisions are made, one for the FEMUR
arthroscope and one for the surgical
instruments to be used in the knee cavity.
MENISCUS
TIBIA
INDICATIONS
UPPER GI ENDOSCOPY
 Dyspepsia
 Abd pain.
 Atypical chest pain.
 Dysphagia
 Vomiting.
 Wt loss.
COLONOSCOPY
 Suspected IBD.
 Altered bowel habits.
 Rectal bleeding or anemia.
 Suspected abnormal Ba enema.
 Therapeutic procedure.
ARTHROSCOPY
 DIAGNOSTIC
 Osteoarthritis
 Post traumatic changes
 Meniscal tears
 Tendon pathology
 Bursitis
 Cartilage injuries
 THERAPEUTIC --- Surgical procedures
LAPROSCOPY
THERAPEUTIC LAPROSCOPY
FINDINGS
ERCP – Normal CBD and ERCP – dilated Common bile duct
pancreatic duct Due to multiple Gallstones
CONTRAINDICATIONS
ENDOSCOPY UGI:
 Severe shock.
 Recent AMI, Unstable angina or arrhythmia.
 Severe respiratory distress.
 Atlanto axial subluxation.
 Suspected perforated viscus.
 These may be relative in experienced hands.
COLONOSCOPY
 Severe shock
 Recent Acute MI,unstable angina & arrhythmias
 Severe respiratory disease
 Suspected intestinal perforation
 severe active Ulcerative colitis
LAPROSCOPY
ABSOLUTE CONTRAINDICATIONS :
 Known or obvious indication for therapeutic intervention, such as
perforation, peritonitis, known intra-abdominal injury, complications
of previous surgery, shock, evisceration, or abdominal wall dehiscence
 Acute intestinal obstruction associated with a massive (>4 cm) bowel
dilatation
 Uncorrected coagulopathy
 A tense or distended abdomen (with suspected intra-abdominal
compartment syndrome)
 Trauma with hemodynamic instability
LAPROSCOPY
RELATIVE CONTRAINDICATIONS :
 ICU patients who are too ill to tolerate pneumoperitoneum, or general
anesthesia
 Presence of anterior abdominal wall infection (cellulitis or soft-tissue
infection)
 Recent laparotomy (within 4-6 weeks) or extensive adhesions secondary to
previous abdominal surgery
 Aortoiliac aneurysmal disease (may be associated with increased risk of
vascular rupture)
 Pregnancy (may be associated with injury to gravid uterus or fetal distress)
 Cardiopulmonary compromise
 Morbid obesity
COLONOSCOPY
 Systemic illness
 Local wounds
 Local infection
 Morbid obesity
 Advanced arthritis
 Degenerative joint disease
BENEFITS VS RISKS
RISKS
UGI ENDOSCOPY/ COLONOSCOPY

 Cardiorespiratory depression due to sedation.
 Aspiration pneumonia.
 Perforation.
 Bleeding.
ARTHROSCOPY:
 Bleeding inside the knee joint.
 Formation of a blood clot in the leg.
 Infection inside the joint.
 Stiffness in the knee.
 Injury or damage to the cartilage, ligaments, meniscus, blood vessels,
or nerves of the kne
LAPROSCOPY:
 Bleeding.
 Infection.
 Hernia.
 Risk of internal damage to structures such as such as blood vessels, the
stomach, bowel, bladder or ureters.
 Adverse reactions to anesthesia.
 Abdominal inflammation or infection.
 Blood clots.
 Potential for a blood transfusion or colostomy.
BENEFITS
 Diagnostic as well as therapeutic

 Direct visualization of viscera
 Biopsy can be taken at the same time

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ENDOSCOPY

 The gastrointestinal tract (GI tract): oesophagus, stomach and duodenum

 An endoscope is a slender, flexible

 a long, flexible tube,

• Not to eat or drink for 8 hours

 For knee arthroscopy only two small

UGI ENDOSCOPY/ COLONOSCOPY

 Diagnostic as well as therapeutic

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