Techniques of UGI endoscopy and normal anatomy
Mohammad Ibrarullah in Atlas of Diagnostic Endoscopy, 2019
Webs, rings and strictures may be developmental or acquired secondary to various gastroesophageal or systemic pathology. Commonly presenting with dysphagia, the conditions pose mechanical difficulty to passage of the endoscope. Diagnosis of postcricoid webs/strictures may be technically difficult as these are obscured by the cricopharyngeus. In such a situation, failure to intubate beyond the cricopharyngeus is often attributed by an inexperienced endoscopist to his own inefficiency or an uncooperative patient. Schatzki's ring is a well-demarcated circumferential stricture located at the squamocolumnar junction comprising mucosa and submucosa. Alcohol, in comparison with other sclerosants, has been associated with a higher incidence of stricture formation. When suspected, the tip of the endoscope should be placed at the esophageal inlet and the patient is asked to take swallows. The obstruction will be apparent when the cricopharyngeus opens transiently during deglutition.
Endoscopy and XRF Cases
Ronald G. Beckett, Gerald J. Conlogue, Andrew J. Nelson in Case Studies for Advances in Paleoimaging and Other Non-Clinical Applications, 2020
Radiography and endoscopy can both provide complementary information regarding the condition of ceramics. The case begins with field radiography, video endoscopy, portable fluoroscopy, and mobile CT scanning. XRF examination of the vestments demonstrated that the metallic threads seen on radiograph were primarily made of copper and silver. The XRF device was focused on one of the raised areas on the side of the mummy’s face where a pellet was known to be lodged as determined by X-ray. XRF analysis was also conducted on the surface of the mummy in several locations with each tracing indicating high concentrations of arsenic. Funerary and conservation practices can be assessed by employing XRF to determine the elemental makeup of materials used in such efforts as was the case of the wax masks of Gangi. The chemical components of mummification and/or embalming solutions can be identified in a nondestructive manner using XRF analysis.
Ear, Nose and Throat
Kelvin Yan in Surgical and Anaesthetic Instruments for OSCEs, 2021
Patient refusal especially when patient cooperation is important. Conditions such as furunculosis and vestibulitis may render it too painful to proceed. Patient refusal especially when patient cooperation is important in nasal examination. Before insertion, a topical anaesthetic is used to numb the area and prevent sneezing. Nasal decongestants are usually given to reduce any nasal membrane swelling to ease passage of the endoscope. It is usually done as an outpatient procedure. Therapeutically, it can be used for the treatment of epistaxis, retrieval or foreign bodies, irrigation and balloon dilatation of sinuses. It is also used during functional endoscopic sinus surgery. Patient refusal, especially when patient cooperation is important given the nature of the procedure. Depending on the indication of the procedure, patients may need to stop their anticoagulants prior to it. Acute epiglottitis, when stimulated, can result in laryngospasm which could lead to respiratory compromise and death.
Endoscopic submucosal dissection of a gastric mass
Published in Baylor University Medical Center Proceedings, 2019
Ahmed Ebrahim, Steven G. Leeds, Jessica S. Clothier, Marc A. Ward
This case report describes the first endoscopic submucosal dissection performed at Baylor University Medical Center for high-grade dysplasia of the stomach. The patient, a 76-year-old man with multiple medical comorbidities, presented with 4 months of abdominal pain. Endoscopy found a mass on the lesser curvature, and endoscopic ultrasound confirmed that it did not invade the submucosa. A complete endoscopic resection was performed, alleviating the need for surgical intervention. Endoscopic submucosal dissection offers a minimally invasive treatment for premalignant lesions and early stage cancers of the stomach. Endoscopic resection is as effective as gastrectomy, with less morbidity in select patients with early stage lesions.
Endoscopic scoring systems for inflammatory bowel disease: pros and cons
Published in Expert Review of Gastroenterology & Hepatology, 2014
Gian Eugenio Tontini, Raf Bisschops, Helmut Neumann
Endoscopy plays a pivotal role for diagnosis and assessment of disease activity and extent in patients with inflammatory bowel diseases. International guidelines recommend the use of endoscopic scoring systems for evaluation of the prognosis and efficacy of medical treatments. Ideal scoring systems are easy to use, reproducible, reliable, responsive to changes, and validated in different clinical settings in order to guide therapeutic strategies. However, currently available endoscopic scoring systems often appear as complex for routine endoscopy and suffer from insufficient interobserver agreement and lack of formal validation which often limit their use in clinical trials. Here, we describe the role of endoscopic scoring systems in inflammatory bowel diseases focusing on pros and cons in the era of advanced endoscopic imaging and mucosal healing.
Zenker’s diverticulum treated via per-oral endoscopic myotomy
Published in Baylor University Medical Center Proceedings, 2020
Ahmed Ebrahim, Steven G. Leeds, Jessica S. Clothier, Marc A. Ward
Zenker’s diverticulum (ZD) is a rare disorder of the esophagus that occurs in approximately 0.1% of the population. Recently, new minimally invasive techniques have been used to treat ZD. Similar to a per-oral endoscopic myotomy (POEM) for achalasia, ZD can be treated using an endoscopic myotomy with a standard endoscope. This technique offers the benefit of a purely endoscopic procedure without the added morbidity associated with the traditional open technique. This is a description of the first per-oral endoscopic myotomy for Zenker’s diverticulum (Z-POEM) performed at Baylor University Medical Center at Dallas.
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