Endoscopy: Transoral (Upper) Endoscopy

Transoral (Upper) Endoscopy

Definitions

  • Esophagoscopy: Endoscopic Evaluation of the Esophagus
  • Gastroscopy: Endoscopic Evaluation of the Stomach
  • Enteroscopy: Endoscopic Evaluation of the Small Intestine
    • Duodenoscopy: Endoscopic Evaluation of the Duodenum
  • Esophagogastroduodenoscopy (EGD): Endoscopic Evaluation of the Esophagus, Stomach & Duodenum
  • Endoscopic Retrograde Cholangiopancreatography (ERCP): Endoscopic Assisted Fluoroscopic Evaluation of the Biliary & Pancreatic Ductal Systems

Antibiotic Prophylaxis

  • Generally Not Indicated
  • Recommended for Variceal Bleeding or Percutaneous Endoscopic Gastrostomy (PEG) Tube Placement

Technique

  • Positioning:
    • Generally Placed in Left-Lateral Decubitus Position with Neck Flexed Forward
      • Once Duodenum Accessed During ERCP: Rotate to Prone Position
    • Placed Supine for Tracheostomy or PEG Placement
  • Camera View:
    • Front-View
    • Side-View – Preferred View During ERCP
  • Tube Rigidity:
    • Flexible Endoscopy: Flexible Tube that Transmits Light/Images Through Fiber Optics
      • Better Tolerated with Decreased Sedation Required
      • Generally the Preferred Option – Improved Manipulation & Navigation
    • Rigid Endoscopy: Rigid Tubes in a Range of External Diameters
      • Provides a Wider Operating Lumen – Advantage in Manipulation of Sharp Foreign Bodies
  • Channels:
    • Single-Channel: Only One Channel for Passage of Instruments
    • Double/Dual-Channel: Two Channels for Passage of Instruments
      • Can Improve Ease of Difficult Foreign Object Removal
  • Esophageal Overtube: Protective Tube Passed Over the Endoscope
    • Used to Protect the Esophagus When Removing Foreign Objects

ERCP Ampulla Anatomy

  • Ampulla – Located at the 12:00 Position Within the Lumen
  • Common Bile Duct (CBD) Orifice – Located at the 11:00 Position Within the Ampulla
  • Pancreatic Duct Orifice – Located at the 1:00 Position Within the Ampulla

Therapeutic Interventions

  • Hemostasis
    • Dilute Epinephrine Injection
    • Thermal Coagulation (Electrocautery or Argon Plasma Coagulation/APC)
    • Endoscopic Hemoclips
    • Fibrin Sealant
  • Endoscopic Mucosal Resection of Tumors
  • Percutaneous Endoscopic Gastrostomy Tube Placement
  • Foreign Body Removal
  • Pneumatic Dilation
  • Stent Placement
  • Ablation of Barrett’s Esophagus
  • Peroral Endoscopic Myotomy (POEM) for GERD
  • Endoscopic Management of Zenker Diverticulum