Gastric Ulcer
Endoscopic field—Flexible Endoscopic view of a big gastric ulcer near the Pylorus. Gastric ulcer [asterisk]; Pylorus(arrow).
The “tucked under” position
The “tucked under” position is usually obtained by advancing the endoscope slightly and deflecting the tip upward.
View of Pylorus
View of pylorus. Bubbles indicating bile provide a clue to the location of the distal stomach when orientation of the side-viewing endoscope is difficult.
Retroflex the endoscope
Retroflex the endoscope to visualize the cardia. A. Perform this maneuver by deflecting the tip sharply back. An owl’s eye view of both pylorus and cardia may be seen as the tip crosses over the incisura. B. As the cardia is identified, move the tip in a
The Pylorus
The pylorus is viewed from the gastric antrum. The endoscope is gently advanced while keeping the pylorus directly in the center of the visual field. Sometimes the pylorus will be observed to open and close. Position the endoscope ready to pass through th
Upper Gastrointestinal Endoscopy
A. The endoscope is advanced down the relatively straight esophagus until the lower esophageal sphincter is identified. B. The lower esophageal sphincter often coincides with the transition from squamous epithelium (white) of the esophagus to mucosa (pink
Minor Tip Deflection with gentle advancement
A. Minor tip deflection with gentle advancement and mild torsion allows the endoscope to traverse bends while maintaining a gentle curve. B. Sharp angulation of the tip (like a candy cane) hinders advancement and may result in paradoxical motion, where th
Rotating wheels on the headpiece of the endoscope
Rotating wheels on the headpiece of the endoscope control tip deflection. Instruments may be passed through an access port, which is kept capped when not in use (to prevent loss of insufflation and splashing of fluids).
Assuring Internal Reflection
A. Internal reflection is assured by cladding each fiber with a coating of high refractive index. Virtually all light is reflected back and forth within the fiber with little loss. B. The image produced by a fiberoptic endoscope is composed of a multitude