1. ENDOSCOPY الدكتور سامر نعمة ياسين الفتلاوي بكالوريوس طب و جراحة عامة / كلية الطب – جامعة الكوفة دبلوم عالي في الطب الباطني / جامعة الكوفة – كلية الطب شهادة البورد ( الدكتوراه ) في الطب الباطني / المجلس العراقي للاختصاصات الطبية bananis83@gmail.com Samern.alfatlawy@uokufa.edu.iq ‎facebook.com/samer.alfatlawy.9

3. DEFINITION

4. Endoscopy, is the examination of internal body cavities using a specialized medical instrument called an endoscope which gives visual evidence of the problem, such as ulceration or inflammation. Physicians use endoscopy to diagnose, monitor, and surgically treat various medical problems and it can be used to collect a sample of tissue; remove problematic tissue, such as polyps and take photograph of the hollow internal organs.

6. HISTORY

7. The word endoscopy is derived from the Greek words "Endo" meaning "inside" and "skopeein" meaning "to see". It is a word used in medicine to describe the procedure used to see inside various parts of the body. Historically, it was known that it is possible to insert tubes into body orifices, but to see clearly a method was needed to illuminate the inside of the organ to be seen. The earliest crude attempts used oil lamps, which were later replaced by small electric filament bulbs. These were not very bright and tended to produce a lot of heat.

8. Medical endoscopy really came into its own after the invention and application of fibre- optic technology to endoscopy. Fibre-optic endoscopes use bundles of thin glass fibres to transmit light to and from the organ being viewed. These fibres use the principle of total internal reflection to transmit almost 100 % of the light entering one end to the other end.

9. WHAT IS ENDOSCOPY?

10. An endoscope is a slender, flexible tube equipped with lenses and a light source. Illumination is done by the help of a number of optical fibers. Reflected light rays are collected by CCD( Charge coupled device) and electrical signals are produced, which are fed to the video monitor to get image. Through one channel of endoscope water and air is conducted to wash and dry the surgical site.

11. COMPONENT

12. Flexible endoscopes are complex and basically, they consist of: 1.A control head. 2.A flexible shaft with a maneuverable tip. 3.A light delivery system to illuminate the organ or object under inspection. The light source is normally outside the body and the light is typically directed via a fiber system. A light source connected to the head via an ‘umbilical’ cord. 4.An Umbilical cord through which pass other tubes transmitting air, water and suction, etc. 5.A lens system transmitting the image from the objective lens to the viewer. 6.An eyepiece. Modern instruments may be video scopes, with no eyepiece. A camera transmits image to a screen for image capture. 7.An additional channel to allow entry of medical instruments or manipulators.

16. INSTRUMENTS & CHANNELS

17. Instruments : A variety of instruments can be fitted to the endoscope for different purposes and the surgeon introduces the endoscope into the body either through a body opening, such as the mouth or the anus, or through a small incision in the skin. Channels: An ‘operating’ channel (usually 2–4·mm in diameter) allows the passage of fine flexible accessories (e.g. biopsy forceps, cytology brushes, sclerotherapy needles, diathermy snares) from a port on the endoscope control head through the shaft and into the field of view The channel size varies with the instrument purpose. 'Therapeutic’ endoscopes with large channels allow better suction and larger accessories.

20. ACCESSORIES

21. 1.Tissue-sampling devices. 2.Suction traps. 3.Fluid-flushing devices 4.Overtubes (sleeves). 5.Electro surgery equipment. 6.Teaching attachments.

22. Tissue-sampling devices 1.Forceps consist of a pair of sharpened cups, a spiral metal cable and a control handle. 2.Cytology brushes have a covering plastic sleeve to protect the specimen during withdrawal.

26. Suction traps Suction traps, such as those used for collecting samples of sputum during bronchial aspiration, are equally useful for taking samples of intestinal secretions and bile.

28. Fluid-flushing devices Flushing fluids through the channel may be necessary to provide optimal views of lesions, particularly in the presence of food residue or acute bleeding.

30. Overtubes (sleeves) These are flexible hoses (24–45·cm long, depending on the indication) designed to fit over the endoscope shaft. Overtubes are mainly used when repeated intubation is anticipated, e.g. for change of endoscopes, removal of multiple polyps, variceal banding or use of muzzle-loaded forceps and biopsy capsules.

32. Teaching attachments Sharing an image from a fibrescope requires a ‘clip-on’ side-arm teaching attachment, or a ‘video converter’, essentially a small CCD chip camera which is applied to the eyepiece of the fibrescope, and transmits the image to a TV monitor (for both the primary operator and assistants).

33. INDICATIONS

34. A health care provider may use endoscopy for any of the following: 1.Investigation of symptoms, such as symptoms in the digestive system including nausea, vomiting, abdominal pain, difficulty swallowing and gastrointestinal bleeding. 2.Confirmation of a diagnosis, most commonly by performing a biopsy to check for conditions such as anemia, bleeding, inflammation, and cancers of the digestive system. 3.Giving treatment, such as cauterization of a bleeding vessel, widening a narrow esophagus, clipping off a polyp or removing a foreign object

35. TYPES

36. There are many different types of endoscope, and depending on the site in the body and the type of procedure. Depending on the body part, each type of endoscopy has its own special term e.g. (Gastroscopy, Colonoscopy, Laparoscopy, Proctoscopy, Cystoscopy, Bronchoscopy, Laryngoscopy,, Arthroscopy, Thoracoscopy).

37. APPLICATIONS

38. 1)The gastrointestinal tract (GI tract): Esophagus, stomach and duodenum (esophagogastroduodenoscopy). Small intestine (enteroscopy). Large intestine/colon (colonoscopy, sigmoidoscopy). Magnification endoscopy. Bile duct: Endoscopic Retrograde Cholangio Pancreaticography (ERCP), duodenoscope assisted cholangio pancreatoscopy, intraoperative cholangioscopy. Rectum (rectoscopy) and anus(anoscopy), both also referred to as (proctoscopy).

39. 2)The respiratory tract The nose (rhinoscopy) The lower respiratory tract (bronchoscopy) 3)The ear (otoscope) 4)The urinary tract (cystoscopy) 5)The female reproductive system (gynoscopy) 6)The cervix (colposcopy) 7)The uterus (hysteroscopy) 8)The fallopian tubes (falloposcopy) 9)Normally closed body cavities (through a small incision): The abdominal or pelvic cavity (laparoscopy) The interior of a joint (arthroscopy) Organs of the chest (thoracoscopy and mediastinoscopy)

40. 10)During pregnancy The amnion (amnioscopy) The fetus (fetoscopy) 11)Plastic surgery 12)Panendoscopy (or triple endoscopy) Combines laryngoscopy, esophagoscopy, and bronchoscopy 13)Orthopedic surgery Hand surgery, such as endoscopic carpal tunnel release Knee surgery, such as anterior cruciate ligament reconstruction Epidural space (Epiduroscopy) Bursae (Bursectomy) 14)Endodontic surgery Maxillary sinus surgery Apicoectomy 15)Endoscopic endonasal surgery 16)Endoscopic spinal surgery

41. RISKS

42. 1.Infection. 2.over-sedation. 3.perforation, or a tear of the stomach or esophagus lining. Although perforation generally requires surgery, certain cases may be treated with antibiotics and intravenous fluids. 4.Bleeding may occur at the site of a biopsy or polyp removal. Such typically minor bleeding may simply stop on its own or be controlled by cauterization. Seldom does surgery become necessary. Perforation and bleeding are rare during gastroscopy. 5.drug reactions. 6.complications related to other diseases the patient may have.

44. SAMPLE PICTURES

45. ESOPHAGEAL STRICTURE

46. EROSIONS