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Video endoscopes are
available in a variety of pediatric to adult sizes.
includes the instrument stack containing a light source,
insufflator, suction, and video recorder/photo printer.
biopsy forceps, snares, and injecting needles.
Keeffe EB, Jeffrey RB,
Lee RG. Atlas of Gastrointestinal Endoscopy.
Philadelphia: Appleton & Lange; 1998.
Martin DM, Lyons RC. The Atlas of Gastrointestinal Endoscopy. http://www.endoatlas.com/atlas_1.html
Murra-Saca J. El
Salvador Atlas of Gastrointestinal Videoendoscopy. http://www.gastrointestinalatlas.com
Owen DA, Kelly JK. Atlas of Gastrointestinal Pathology.
Philadelphia: WB Saunders; 1994.
Schiller KF, Cockel R,
Hunt RH, et al. A Colour Atlas of Gastrointestinal
Endoscopy. Philadelphia: WB Saunders; 1987.
Silverstein FE, Tytgat
Guido NJ. Atlas of Gastrointestinal Endoscopy.
St. Louis: Mosby; 1997.
Tadataka Y. Atlas
of Gastroenterology. Philadelphia: Lippincott
Williams & Wilkins; 2004.
Dyspepsia unresponsive to
Periodic surveillance of
patients with biopsy-proven Barrett esophagus
Persistent vomiting of
Documentation of H. pylori
of undigested food
Periodic monitoring of
patients with gastric polyps or Gardner syndrome
clearance of gastric ulcers
Atypical chest pain with
negative cardiac workup
symptoms unresponsive to medical therapy
Evaluation of upper
intestinal or gastric obstruction
Dyspepsia associated with
serious signs such as weight loss
Evaluation of abnormal
Screening for gastric
cancer (especially in high-risk populations such as the
Known or suspected
Acute, severe, or
unstable cardiopulmonary disease
Coagulopathy or bleeding
Severe or active upper
therapeutic EGD that cannot be performed by the practitioner in
PITFALL: The benzocaine spray has a
pungent taste, even with flavoring added. Warn the patient
about the taste, and allow time for a brief respite before
the second spray.
Pearl: The advantage of using a downward
deflection is the tip cannot be overly deflected (it will
bend only 90 degrees downward).
PITFALL: The patient often gags when the
scope is inserted. As soon as intubation is accomplished,
stop and prevent movement of the scope tip. This allows the
patient to resume normal respiratory pattern and become
accustomed to the sensation created by the tube. Calm verbal
encouragement should be used to assist the patient through
this most difficult aspect of the procedure.
PITFALL: Tracheal intubation can happen if
the tube is forcibly inserted with the scope tip positioned
over the vocal cords. The endoscope usually produces gagging
and distress from the inability to breath and possibly from
laryngospasm. The scope should be completely withdrawn if
tracheal intubation is suspected or occurs (i.e., tracheal
rings are visualized).
PITFALL: The longer the scope is in the
stomach, the greater is the degree of pylorospasm. Rapid
intubation of the duodenum is advocated to reduce difficulty
in passing through the pylorus.
PITFALL: Often, the scope tip slips back
into the stomach, and the scope must be reinserted into the
PITFALL: Do not biopsy pulsatile or
vascular lesions, because the resulting bleeding can be
extensive and difficult to control.
PITFALL: Esophageal ulcerations or
erosions may be better assessed by brushing or washing. The
esophagus is much thinner than the stomach, and risk of
perforation from biopsy is greater at this location. Beware
of biopsying the base of a deep gastric ulcer, because
perforation can occur in this situation.
PITFALL: Lesions in the proximal esophagus
may be missed upon initial insertion of the endoscope.
Examine this area carefully.
Perforation of stomach,
esophagus, or duodenum
Bleeding at biopsy
Adverse reaction to
anesthesia or medication, including
Corporation, Center Valley, PA. Web site: http://www.olympusamerica.com.
Precision Instrument Corporation, Montvale, NJ. Web site: http://www.pentaxmedical.com
2% lidocaine topical solution is available from Alpharma USPD,
Bridgewater, NJ. Web site: http://www.alpharma.com.
20% spray (Hurricaine topical anesthetic) is
available in several flavors from Beutlich Pharmaceuticals,
Waukegan, IL. Web site: http://www.beutlich.com
can be obtained from Tri-Med Specialties, Roswell, GA. Web
Butorphanol tartrate (Stadol) nasal
spray is available from Bristol-Myers Squibb. Web site: http://www.bms.com.