Endoscopy in Clinical Surgery and Practice

Endoscopy
Endoscopes
Uses of Endoscopy
Classification of Endoscopy
Patient preparation
Complications
Sigmoidoscopy
Upper GI
Lower GI
Colonoscopy

1. Endoscopy in C linical Surgery B.M.A.D. DESHANI W.S.A. DESHAPRIYA D. DEVANARAYANA H.H.K.T. DHARMASIRI K.V.D. DIAS

2. Endoscopy The process of inspecting both internal body cavities & epithelium lined organs by the means of rigid or flexible instrument. This may be through a natural orifice e.g.: oesophagoscopy, sigmoidoscopy Through a surgically created hole e.g. : arthroscopy, laparoscopy Endoscope Instrument used to examine the interior of a hollow organ or cavity of the body 2

3. endoscopes Rigid Flexible 3

4. 4

5. Uses of endoscopy Investigation of symptoms e.g. : difficulty in swallowing, GI bleeding , abdominal pain, nausea , vomiting Diagnostic e.g. : biopsy in anemia , bleeding, inflammation, cancers of GI tract Therapeutic e.g. : widening of narrow esophagus , cauterization of bleeding vessel, clipping off a polyp Monitoring & screening e.g. : Gastric carcinoma,colorecatal carcinoma Research 5

6. classification The GI tract - O esophagus ,stomach & duodenum – Oesophagogastroduodenoscopy - Small intestine – Enteroscopy - C olon – Colonoscopy . Sigmoidoscopy - Bile duct – ERCP - Rectum & anus – P roctoscopy The urinary tract – Cystoscopy The respiratory tract - Upper respiratory tract - Rhinoscopy ,Laryngoscopy - Lower respiratory tract - Broncoscopy The ear – Otoscopy 6

7. The female reproductive system T he cervix- Colposcopy The uterus – Hysteroscopy The fallopian tube – Falloposcopy Closed body cavities - T he abdominal , pelvic cavity – Laparoscopy Joint interior – Arthroscopy Intrathoracic – Thoracoscopy & Mediastinoscopy Vascular - Arterioscopy 7

8. Upper GI Endoscopy Gastroscopy/ oesophago -gastro- dudenoscopy (OGD) Endoscopic Retrograde Cholangio Pancreatography (ERCP) Enteroscopy 8

9. OGD Indications Investigation of; Dysphagia Dyspepsia, reflux disease, upper abdominal pain Acute or chronic upper GI bleeding IDA (with colonoscopy) Therapeutic intervention of upper GI pathology; Balloon dilatation of benign strictures Endoluminal stenting of malignant strictures Injection, coagulation or banding of bleeding sources including ulcers, varices , tumours & vascular malformation 9

10. Patient preparation & procedure Informed written consent 6-8 hrs fasting (except in emergencies) IV access 10% lignocaine spray to the pharynx IV Midazolam 2-5 mg Hyoscine bromide 10mg White balance Insert the mouthpiece Lubricate the OGD with Lignocaine gel Instruct the patient to cooperate Measure the distance from incisor teeth to the lesion Take biopsy if necessary Advice patient not to swallow until the effect of anaesthetic is over 10

11. Complications Perforation -highest in elderly with oesophageal pathology Bleeding -commonest after biopsy or therapeutic procedure Respiratory depression and arrest -over medication and sedatives 11

12. ERCP Indications Investigation of Billiiary dd - bile duct stones ,biliary strictures, biliary tumours,biliary injuries,intrahepatic biliary disease Pancreatic dd - pancreatic duct strictures and abnormalities Therapeutic intrventions for pancreatico –biliary disease Stenting for common bile duct stones,strictures,tumours Sphincterotomy for the extraction of biliary stones 12

13. Patient preparation Informed written consent Fasting 4 hrs IV access Lignocaine spray to the pharynx IV Midazolam 5mg Analgesia occassionaly – Pethidine 50mg or fentanyl 13

14. Complications Perforation of oesophagus or duodenum Bleeding – usually controlled by balloon pressure Acute pancreatitis Septicemia Respiratory depression and arrest 14

15. Lower GI Endoscopy Colonoscopy Sigmoidoscopy 15

16. Colonoscopy Visualize the entire colon Indications - investigation of rectal bleeding - colorectal cancer screening and assessment - evaluation and removal of colonic polyp - assessment of colitis - management of inflammatory bowel disease - decompression of colonic volvulus Contraindications - pregnancy 16

17. Patient preparation Informed consent IV access Fasting for 12 hours Instruct the patient to take - light breakfast day before the procedure - clear fluids Bowel preparation – Klean prep - 1 sachet is dissoloved in 1 L of water Given over a period of 1 hour Next hour patient is allowed to take clear fluids Repeat the procedure up to 4 sachet Adequate hydration 17

18. Procedure Position the patient left lateraly IV midazolam 2-3 mg Hyscosine bromide Connect to pulse oxymeter Lubricate the colonoscope with lignocaine Explain the following to the patient while doing the procedure ; - feeling to pass flatus or faeces - abdominal pain 18

19. Sigmoidoscopy Rigid sigmoidoscopy Visualise upto recto-sigmoid junction Indications Ix of rectal bleeding, mucous diarrhoea , tenesmus To obtain biopsy To aceess the true height of rectal cancers (distance from anal verge) Conservative Rx of sigmoid volvulus Flexible sigmoidoscopy Visualise upto splenic flexure(60 cm from the anal verge) Indications Screening for colorectal cancers Pre op evaluation before anorectal surgery Surveillance of previously diagnosed colorectal malignancy Removal of foreign bodies To take biopsy To perform therapeutic procedures ( eg : balloon dilatation) 19

20. Rigid sigmoidoscopy Flexible sigmoidoscopy Contraindications Bowel perforation Anal stenosis Acute peritonitis Colonic necrosis Fulminant colitis Acute diverticulitis Toxic megacolon Recent colonic surgery Anal fissures Contraindications Bowel perforation Acute diverticulitis Active peritonitis Fulminant colitis Cardiopulmonary instability 20 Relative Absolute

21. Patient preparation Informed consent Bowel preparation - rigid sigmoidoscopy – microenema - flexible sigmoidoscopy – Phosphate enema IV Midazolam if required 21

22. Cystoscopy Under LA Indications -UTI - Haematuria -Urinary incontinence -Prostatic enlargement - Urinanary calculi -Suspected malignancy in urinary tract 22 Flexible R igid Under GA

23. Patient preparation Informed consent Check a urine sample to find any infection Urinate and come prior to the procedure Preparation of genitalia using an antiseptic solution Cover the area with sterile drapes Complications Dysuria Haematuria Frequency UTI Bleeding Perforation of bladder 23

24. Bronchoscopy Visualize the larynx ,trachea, segmental bronchi 24 Rigid Mainly for therapeutic purposes Indications - stent placement - pulmonary abscess drainage - foreign body removal - tracheobronchial tree cleansing Under GA Flexible Mainly for Diagnostic purposes Indications - chronic cough - vocal cord problems - pulmonary abscess - mediastinal neoplasia Under LA

25. Laryngoscopy Use to visualize oral cavity ,oropharynx, vocal cords. Thoracoscopy Introduced through an incision of chest to gain access to the thoracic cavity Mediastinoscopy Visualization of the content of the mediastinum For obtaining a biopsy ( lung cancer, Lymph nodes ) 25

26. Advantages No GA is needed Usually well tolerated Biopsies are taken under direct visualization Can be used for management of patients Disadvantages Tissue biopsies are small due to small size of biopsy canal 26

27. Complications Bleeding - From mucosal injury , perforation sites and biopsy sites Infection - due to cross infection of HIV and HBV - Prophylaxis antibiotics are important in high risk patients Perforation of hollow viscus Pulmonary aspiration Intestinal obstruction 27

28. How to clean the endoscope? By Teepol Should brush the inside of endoscope Then clean with running water Finally clean with cidex solution 28

29. Thank you 29