Endoscopy of the Upper GI Tract: A Training Manual

210 Pages·2004·31.81 MB·English

by  Berthold Block

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I
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Endoscopy of the
Upper GI Tract
A Training Manual
Berthold Block, M.D.
Braunschweig
Germany
Guido Schachschal, M.D.
Universitäts-Klinikum Charité
Berlin
Germany
Hartmut Schmidt, M.D.
Universitäts-Klinikum Charité
Berlin
Germany
774 illustrations
56 tables
Thieme
Stuttgart · New York
III
LibraryofCongressCataloging-in-PublicationDataisavailablefrom Importantnote:Medicineisanever-changingscienceundergoing
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tinuallyexpandingourknowledge,inparticularourknowledgeof
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ThisbookisanauthorizedtranslationoftheGermaneditionpub- authors, editors, and publishers have made every effort to ensure
lished and copyrighted 2003 by Georg Thieme Verlag, Stuttgart, thatsuchreferencesareinaccordancewiththestateofknowledge
Germany. Title of the German edition: Der Gastroskopie-Trainer: atthetimeofproductionofthebook.
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IV
Preface
Attempts to look into human body orifices and body cavities necessary interventions can be carried out in the same sitting.
date back to antiquity. Most of these efforts met with little Uppergastrointestinalendoscopyissafeandeasytoperformfor
success because of poor illumination. A breakthrough came in experiencedendoscopists.
1806whenPhilipBozziniintroducedhisLichtleiter(“lightcon- Thequalityoftheexaminationdependsupontheinterplay
ductor”), which supplied at least a theoretical solution to the betweentheendoscopictechniqueandtheinterpretationofthe
problem.Bozziniwasthefirsttoenvisionthefutureapplication images. Anyone who is learning endoscopy is bound to en-
ofendoscopesinurology,gynecology,andgastroenterologyand counter technical difficulties at first. For this reason, we have
theeventualdevelopmentoflaparoscopy. provided ample didactic information to supplement the atlas
Adolf Kussmaul introduced the rigid gastroscope in the portionsofthisbook.
1890s. The gastroscopes used during the first half of the 20th Endoscopic interventional procedures have been practiced
century were semirigid devices in which lens systems trans- formorethan30years.Therangeofendoscopictreatmentop-
mittedtheimagetoaneyepiece.Amajoradvancecameinthe tionsisconstantlyexpanding,andexaminersareoftenexpected
mid-20thcentury,whenBasilHirschowitzdevelopedaflexible toperformtheseinterventionsintheearlyphaseoftheirendo-
fiberopticendoscope.Buteventhistechnologyappearstohave scopic training. Established therapeutic procedures are de-
been superseded by the development of video endoscopy and, scribedinsomedetail,therefore.
morerecently,bywirelesscapsuleendoscopy. Wehopetoprovideourreaderswithaneasy-to-use,com-
As endoscopy has evolved, the instruments have become prehensiveintroductiontothemethodanditscapabilities,and
moreflexibleandtheirouterdiameterssmaller,makingtheex- wewishthemmuchsuccessandsatisfactioninthepracticeof
e
aminationmucheasierforboththeendoscopistandthepatient. gastrointestinalendoscopy. ac
f
Today,uppergastrointestinalendoscopyisthemostrewarding e
r
P
procedure for investigating complaints of the upper gastroin- BraunschweigandBerlin,spring2004 BertholdBlock
testinal tract. Visual inspection, specimen collection, and any GuidoSchachschal
HartmutSchmidt
V
Acknowledgments
Wewishtorecognizeallthosewhocontributedtothesuccessof thegraphicswerebasedondrawingsbyMr.MichaelGradiasof
thisbook.Wethankthefollowingcolleaguesforprovidingen- Wolfenbüttel (originally done for the Teaching Atlas of Gastro-
doscopicimages: scopy.Stuttgart:Thieme;1997).
We thank the excellent staff at our endoscopy unit at the
Dr.med.DirkBandorski,FuldaMedicalCenter,MedicalClinicII,
CharitéHospitalfortheirhelpandpatienceinobtainingtheen-
Pacelliallee4,36043Fulda.
doscopic images: Mrs. Ingrid Olerich, Mrs. Silvia Meinert, Mrs.
Dr.med.ChristianBömecke,AgnesKarlHospital,Hildesheimer Dagmar Nitschke, Mrs. Martina Linser, Mrs. Marion Doss, Mrs.
Strasse158,30880Hanover−Laatzen. MarionStrelow,Mrs.GritGartmann,Mrs.AnnetteKlameth,and
Mr.FrankMaltzahn.
Dr. med. Thomas Koch, Medical Clinic I, St. Walburga Hospital,
Itisonethingtowritetextandobtainendoscopicimages,
Schederweg12,59872Meschede.
butitisquiteanothertoturnthemintoabook.Wearegrateful
(http://www.info-endoskopie.de)
tothestaffatThiemeMedicalPublishersforpresentingourtext
Dr.med.WernerSchmidtbaur,AugsburgMedicalCenter,Medi- andendoscopicimagesinsuchanexquisiteform.WethankDr.
nt calClinicIII,Stenglinstrasse2,68156Augsburg. Antje Schönplug and Mrs. Marion Holzer for their tireless ef-
e
m forts. We also thank Dr. Markus Becker, who contributed so
We are grateful to Mr. Horst Wesche, of the German Photo-
e muchtothesuccessofthisbookduringallphasesofitsplanning
g graphicSocietyinHanover,forkindlyprovidingtheimagesper-
d andproduction.
e tainingtoduodenaltubeplacement.
wl
o BertholdBlock
kn WethankMrs.StephanieGayandMr.BertSenderofBremenfor GuidoSchachschal
c
A turning our rough drawings into superb illustrations. Some of HartmutSchmidt
VI
Abbreviations
ALA aminolevulinicacid LES loweresophagealsphincter
AP anteroposterior MALT mucosa-associatedlymphoidtissue
ARDS adultrespiratorydistresssyndrome NPO nothingbymouth
CMV cytomegalovirus NSAIDs nonsteroidalanti-inflammatorydrugs
CT computedtomography PCR polymerasechainreaction
ECG echocardiogram PEG percutaneousendoscopicgastrostomy
EGD esophagogastroduodenoscopy PEJ percutaneousendoscopicjejunostomy
ENT ear,nose,andthroat PPI protonpumpinhibitors
GAVE gastricantralvenousectasia TIPS transjugularintrahepaticportosystemicshunting
GI gastrointestinal(onlyin“upperGIendoscopy”) TTC through-the-channel
HSV herpessimplexvirus TTS through-the-scope
s
n
o
ti
a
vi
e
r
b
b
A
VII
Contents
90 M 30
1 General
... 1
IndicationsandContraindications ... 2
RisksandComplications:CardiacandPulmonary ... 3
s LocalAnesthesia ... 3
t
en SedationandAnalgesia ... 3 2 Examination Technique
t
n CardiacComplications ... 3 and Normal Findings
o ... 20
C RespiratoryComplications ... 3
InsertingtheEndoscope ... 22
RisksandComplications:Gastrointestinal ... 4
BasicRules ... 22
PerforationandBleeding ... 4
BlindInsertion ... 23
Infection ... 4
WithVisualControl ... 23
EndoscopySuite:FacilitiesandStaff ... 5
PassagethroughtheUpperEsophagealSphincter ... 23
ProcedureRoom ... 5
Direct-VisionInsertion ... 24
Staff ... 5
Problems ... 24
EndoscopyUnit ... 5
Direct-VisionInsertion:FourPhases ... 25
EndoscopySuite:Endoscope ... 6
UpperEsophagealSphincter ... 26
EndoscopySuite:Accessories ... 7
Anatomy ... 26
EndoscopicAccessories ... 7
Physiology ... 26
EmergencyEquipment ... 7
DocumentationofFindings ... 7 CervicalEsophagus ... 27
Anatomy ... 27
PreparationsforEndoscopy:InformedConsent ... 8
DisclosureandInformedConsent ... 8 MiddleEsophagealConstriction ... 28
Anatomy ... 28
PreparationsforEndoscopy:Medications(1) ... 9
PremedicationandMedications InspectingtheMiddleEsophagealConstriction ... 29
UsedDuringtheProcedure ... 9
RetrocardiacEsophagus ... 30
PreparationsforEndoscopy:Medications(2) ... 10 Anatomy ... 30
ChecklistsBefore,During,andAfter DistalEsophagusandLowerEsophagealConstriction ... 31
theExamination ... 11 Anatomy ... 31
DiagnosisandTreatmentofComplications(1) ... 12 GastroesophagealJunction ... 32
ComplicationsDuringtheExamination ... 12 Anatomy ... 32
Physiology ... 32
DiagnosisandTreatmentofComplications(2) ... 13
ClosureMechanisms ... 32
DiagnosisandTreatmentofComplications(3) ... 14
LowerEsophagealSphincterandDiaphragmaticHiatus ... 33
ComplicationsImmediatelyAfterthe
Anatomy ... 33
ExaminationorAfteraComplaint-FreeInterval ... 14
Z-Line ... 34
DiagnosisandTreatmentofComplications(4) ... 15
Anatomy ... 34
DiagnosisandTreatmentofComplications(5) ... 16
SwallowingandEsophagealMotility ... 35
EndoscopicTechnique:StepsinLearning ... 17
Physiology ... 35
LearningtheExaminationTechnique ... 17
TerminologyofEsophagealMotility ... 35
HandlingtheEndoscope ... 17
ExaminingtheStomachDuringInsertion ... 36
EndoscopicTechnique:ManeuveringtheScope ... 18
TechnicalAspects ... 36
EndoscopicTechnique:Functions ... 19 AdvancingtheEndoscope ... 36
VIII