2. Unit-5

3. What is Endoscopy? Endoscopy is the examination and inspection of the interior of body organs, joints or cavities through an endoscope to allow physicians to peer through the body's passageways. Endoscopy is the examination and inspection of the interior of body organs, joints or cavities through an endoscope to allow physicians to peer through the body's passageways. An Endoscope is a device using fiber optics and powerful lens systems to provide lighting and visualization of the interior of a joint. The portion of the endoscope inserted into the body may be rigid or flexible, depending upon the medical procedure. An Endoscope is a device using fiber optics and powerful lens systems to provide lighting and visualization of the interior of a joint. The portion of the endoscope inserted into the body may be rigid or flexible, depending upon the medical procedure.

4. Introduction ENDO – inside SCOPY- viewing Endoscopy means looking inside An endoscope is using fiber optics and powerful lens systems The endoscope may be rigid or flexible It is a minimally invasive diagnostic medical procedure. Endoscopy can be done on an outpatient basis. Inserted through a natural body opening or through holes made. Small biopsies and foreign objects can be taken.

5. RIGID SCOPE FLEXIBLE SCOPE

6. Hardware A fiber optic cable is simply a bundle of microscopic glass or plastic fibers that literally allows light and images to be transmitted through curved structures. There is also a separate port to allow for administration of drugs, suction, and irrigation. This port may also be used to introduce small folding instruments such as forceps, scissors, brushes, snares and baskets for tissue excision (removal), sampling. New endoscopes have digital capabilities for manipulating and enhancing the video images.

7. Types Gastroscope: For visual examination of the upper gastro-intestinal (GI) tract. Colonoscope: To examine the inside of the colon and large intestine Cystoscope: To examine the bladder, urethra, urinary tract, uteral orifices, and prostate (men) with insertion of the endoscope through the urethra. Duedenoscope: It is used to examine the liver's biliary tree, the gallbladder, the pancreatic duct and other anatomy to check for stones, other obstructions. Bronchoscope: To examine of the trachea and lung's bronchial trees. Sigmoidoscope: To examine the rectum, and the sigmoid and descending portions of the colon. Colposcope: For direct visualization of the vagina and cervix to detect cancer, inflammation, and other conditions. Laryngoscope: To examine of the larynx.

8. SURGICAL ENDOSCOPY (RIGID ENDOSCOPY) -Laparoscopy. -Arthroscopy. -Endo-Urology. -Gynecology. -E.N.T-applications. -Proctoscopy. -....And many other surgical applications (gastrectomy,neurosurgery,…etc).

9. ARTHROSCOPY LAPAROSCOPY

10. RIGID ENDOSCOPE

11. CARE OF RIGID ENDOSCOPE Rigid endoscopes must be handled with care, they are very delicate and can be damaged easily if dropped or hit against hard objects. Can be disinfected via gas sterilization or autoclaved if specified by manufacturer or soaked in 2-3% glauteraldahyde sol’n mosltly used safe disinfection technique.

12. FLEXIBLE ENDOSCOPY UPPER GI ENDOSCOPY LOWER GI ENDOSCOPY RESPIRATORY ENDOSCOPY

13. UPPER GI ENDOSCOPY Gastroscopy Duodenoscopy (ERCP) Enteroscopy

14. History The first endoscope, was developed in 1806 by Philip Bozzini.  Introduced into a human in 1853.  Use of electric light was done by David in 1908  The initial devices were fully rigid.  In the 1930s, semi-flexible endoscopes were developed to see stomach.  Fiber-optic endoscopy was pioneered by Basil Hirschowitz in 1957.  Widespread use of fiber optic endoscopes began in the 1960s

15. Principle of Working An endoscope uses two fiber optic lines. A "light fiber" carries light. An "image fiber" carries the image Endoscopes may be used in conjunction with a camera or video recorder In video endoscopes CCD (Charge Coupled Device) carries the image CCD type may be either monochrome or color chip.

16. Hardware

19. Operation Flexible endoscopes passed in to the human body through natural openings, and is directed with the help of angulation knobs. Light is passed in through Light fibers. Image is passed through image bundles / CCD. Biopsies are taken via operation channel. Air for inflation and water to clean the distal end of the scope during procedure, can be passed through Air / Water channels.

20. PPM Clean the Outer Sheath Wash. Brush the channels Clean the channels Disinfect or sterilize Check the cap. Check the fibers.

21. BROKEN FIBERS GOOD FIBERS

22. Internal parts

23. Endoscopic laser coagulation Diagram (right side)of gastric optical coagulation using argon ion laser as high energy optical source and endoscope as delivery unit. Argon laser-green light –highly absorbed by through RBC vessels and Hb So it is very useful in the coagulation which is result in photocoagulation of blood protein and microhemostasis

24. Contd.. With the help of fiber optic endoscope,the output from argon laser is deliver to the required spot to arrest the gastric bleeding. Can move the laser beam in any direction with the flexibility endoscope Argon ion laser gives an output of 13 watts in the form of contd. Waves Diameter quartz fiber endoscope -2mm

26. Safety 1.Using too much enzymatic solution. 2.Not attaching the soaking cap. 3.Squeezing too tightly when wiping. 4.Brushing the channels too roughly. 5.Not carefully clearing work channel. 6.Storing/transporting the scope carelessly 7.Reprocessing with other instruments 8.Waiting too long to irrigate. 9.Not adequately testing for leaks. 10.Not removing jewelry.

27. Recent developments Total brushability- User can clean all the channels. In recent years having a camera, called a CAPSULE CAMERA or video pill at the distal end of the optical system to project findings on a video system.

29. There's nothing which can reach the insides of the small intestine, except for the capsule endoscopy. Earlier, patients had to go through a surgery even for the diagnosis," said Dr Ravindra BS, chief of medical gastroenterology, BGS Global Hospital. “ The capsule is just like a vitamin tablet. We can stop the movement of the capsule at certain points, with a magnet. Three years ago, when the technique was introduced, it cost over Rs 1 lakh. Now, the cost has come down to Rs 35,000, which many can afford." After fasting overnight, the capsule is given with a glass of water, after which the patient isn't given anything to eat or drink for four to six hours. After this time period, only liquids are given. The capsule moves slowly through the intestine for 10 hours, and later comes out of the rectum.