1
Q
No light at distal end
A
- Light source plug - Plugged in & on.
- Not in stand by mode.
- Clean scope tip.
- Burnt out Bulb.
- Dirty distal lens.
2
Q
Irrigation solution
A
Sterile water
Saline crystallizes in channel
3
Q
Out of focus
A
- White balance
- Clean lens
4
Q
No irrigation
A
- Bottle contains water
- Bottle connected to umbilical cord
- Connection too tight
- Bottle lid too tight
- Power on
- Occluded/stuck valve
5
Q
No insufflation
A
- Umbilical cord seated in light source. Needs to be screwed in
- Power turned on
- Stuck/Occluded valve
6
Q
Clogged valve/nozzle
A
- Clean valve
- Flush channel with cleaning solution, followed by clean water
7
Q
Unable to pass instrument
A
- Correct size selected
- Instrument tip closed
- Decrease tip deflection
8
Q
Routine “high level disinfection”
A
Gluteraldehyde
Disinfection doe not work with foreign materials
9
Q
Sterile “Overnight” cycle
A
Ethylene Oxide Gas
10
Q
Location of suction port
A
5 - 7 O’Clock
11
Q
Cart
A
- Monitor
- Video processor
- Light source
- Water bottle
- Image printer/recorder
12
Q
Umbilical cable
A
Air & water valve
13
Q
Umbilical cable - Partial depress
A
Air
14
Q
Umbilical cable - Complete depress
A
Cleans lens
Withdraws air to force water into camera
15
Q
Light cord
A
Coherent stacks of optic fibers
16
Q
Positioning: ERCP
A
Prone with head to right
Left lateral decubitus if difficulty intubating duodenum
Supine: Associated with higher difficulty in intubating the papilla
17
Q
Positioning: Colonoscopy
A
Left lateral decubitus
18
Q
Positioning: APR
A
Supine
19
Q
Fiber optic endoscope
A
Fragile
Fibers break = Dark spots on screen
Bronch and choledocoscopes only
20
Q
Video endoscopes
A
Contraindication: Stricture (Can test with dummy pill)
Pregnancy
MRI
Dysphagia (Can endoscopically be placed in stomach)
Prep: NPO x 8hrs
Simethicone, Reglan, PEG
21
Q
Timing of endoscopy in ESRD
A
Day after HD
22
Q
Risk during Colonoscopy
A
Minor: Hypoxia (5.6%), hypotension, bradycardia, arrhythmia
23
Q
Preprocedural labs
A
None
Cardiac Hx: EKG
Respiratory Hx: CXR
Coags: Hypocoaguability
General anesthesia: Pregnancy screen
24
Q
Iso-osmotic (Polyethlene glycol PEG)
A
Safe in CHF, ESRD, Elecrolyte abnormaities, Liver disease
25
Hyperosmolar (Magnesium Citrate)
Better tolerated
Induces CCK release
26
Sodium Phosphate
Adverse effect: Hyperphosphatemia, Hypokalemia
Contraindication: CKD, AKI, CHF, ACS, lleus, Ascites, Pediatrics
27
Indication for antibiotics
Endocarditis risk (Prosthetic valve, prior endocarditis, surgical shunt, Tetrology of fallot, congenital heart disease, MVP, HOCM, valvular disease)
Esophageal dilation
Variceal sclerotherapy
ERCP (w/ ductal obstruction)
Pancreatic lesions
Percutaneous gastrostomy tubes
28
Safe INR
<1.5
29
ASA/NSAIDs
No contraindication for endoscopy
30
Post Colonoscopy
Major: Perforation, Bleeding, Post scope syndrome, Bronchospasm (0.07%)
31
Mortality: Colonoscopy
0.007%-0.001%
32
Mortality: EGD
0.0001% (1:10,000)
33
Procedural monitoring
Pulse Ox
Verbal stimulation
End tidal CO2
Vitals q 5 min
Telemetry
34
Risk factors for ERCP desaturation
Age >60
ASA >3
Procedural length
35
Monitoring: COPD
Use capnography to detect CO2 retention
36
Prior to each drug administration
Always check BP
37
Propofol
Preferred
Continuous End tidal and EKG
38
Midazolam
Shorter duration
Less venous irritation
Water soluble
Anterograde amnesia
39
Flumazenil
Risk of seizures with chronic benzodiazepine use
40
Remifentanyl
Better than propofol
Better HD stability
Better patient satisfaction
Shorter recovery time
Same respiratory depresssion
41
Half life of Narcan
60-90 minutes
42
Nitric oxide
Not tolerated well
43
Precedex
HD instability
Required analgesic
Longer recovery
Difficult administration
44
Contraindications: Small caliber endoscopy
Coagulopathy
Prior naso/oro/hypopharynx surgery
45
Complications: Small caliber endoscopy
Vagal stimulation
(Hypotension, hypoxia, epistaxis)
46
Anesthesia: Small caliber endoscopy
Lidocaine + Benzocaine + Oxymetazoline
47
Side effect of Lidocaine + Benzocaine + Oxymetazoline
Aspiration
Methemoglobinemia
Anaphylaxis
48
Complication rate: EGD
1.4%
49
Complication rate: Colonoscopy
0.42%
Most common: Missed polyps
50
Conscious sedation
Higher rate of mortality and morbidity
51
Bispectral index (BIS) monitoring
Score 0-100
0 = Coma
82 = Endoscopy
100 = Awake
Low accuracy in detecting deep sedation
52
Discharge criteria
Alert
Ambulating
Tolerating Clears
53
Surveillance: FAP
Q 1-2 years
Age: 10
Rule out duodenal neoplasm with EGD
54
Surveillance: Barretts (Low
Risk)
< 3 cm
Q 2 years (No dysplasia)
55
Surveillance: Barretts (Medium risk)
>3 cm
Q1 year
56
Surveillance: Barretts (High risk)
Low grade dysplasia
Q 6 months
57
Surveillance: Varices w/ sclerotherapy
Q 6-8 weeks
58
Surveillance: Gastric or esophageal ulcer
Q6 weeks
Until ulcer healed w/ biopsy/brushing
59
Surveillance: Pernicious anemia
Single endoscopy
No follow up
60
Contraindications: EGD
HD unstable
Cannot tolerate sedation
61
Positioning: EGD
LLD
Head elevated
Turn to right for fundus bleeding
62
Technique: EGD scope introduction
Insert to posterior pharyngeal wall
Tip up to epiglottis
Deflect down to aretynoids
Marker: 15 cm
63
Technique: Passing duodenal superior angle
90 Right
Angle up
Dial right
64
Avoiding aspiration on EGD
Bite block reverses jaw thrust
Monitor
- Gastric distention
- Sedation level
- Head elevation
- Fluid removal from gastric fundus
- Decompression prior to scope withdrawal
65
Areas of perforation: EGD
Cricopharyngeus
Pharynx
Superior duodenum
66
Morbidity (Most common): EGD
Respiratory depression (drug induced) - 70%
Airway obstruction
67
Biopsy: EGD
Only biopsy mucosal lesions
Submucosal lesions = EUS/ FNA
68
Surveillance: Colonoscopy
Age: 45 - q10 years
First degree relative with colorectal cancer at 40 yrs or 10 yrs before youngest relative
< 60 years onset : q 5 years
> 60 years onset: q 10 years
69
Surveillance: HNPCC
Age: 20 - 25 years
Q 1-2 years colonoscopy
10 years prior to family member diagnosis
70
Proctoscope
Cannot assess posterior wall of rectum
71
Contraindications: Colonoscopy
Absolute: Peritonitis
Relative: Anal fissure, recent MI, PE, SBO
72
Scope size that reaches cecum
160 cm
73
Scope size for flex sigmoidoscopy
70 cm
74
Technique: Rectosigmoid junction
Tip deflection
Counterclockwise torque
Clockwise torque
75
Technique: Colonic loops
Withdraw/ jiggle scope
Apply external pressure on sigmoid to hold loop in place and prevent formation
76
Location of torque removal
Descending colon/sigmoid (circular muscle) junction
77
Techniques: Splenic flexure
Slit or fold
Down + Left
Place patient on back or to the right to open slit
Shorten scope once traversed (<50 cm)
78
Transverse colon
Triangular
Evacuate air to lessen difficulty of traversing hepatic flexure
Apply abdominal pressure/ place patient on back
79
Hepatic flexure
Straight up
Blue hue of liver
80
Technique: Ascending colon
Clockwise torque
Tip down + right
Loop reduction
Suction
Place patient to right/ back
70 cm
81
Anatomy: Ascending colon
Green mucus
Large diameter
82
Cecum
Crow’s feet (confluence of tenias and ICV) —> Appendiceal orifice
83
Technique: Terminal Ileum
ICV at bottom of screen
Tip down to valve
Insufflate to open valve
80/90 cm
Can retroflex into cecum = high risk of perforation
84
Scope withdrawal time
6 minutes
Adenoma detection rate: Men 30%, WOmen 20%
85
Poor prep
Can abandon colonoscopy
Stool balls in large diverticulum will be present despite repeat preps
86
Mucosa stuck in port
Remove cap on instrument
87
Rigid endoscopy
Most accurate way of localizing rectal lesions and measurement
88
Localizing lesion for removal
Tattooing with carbon microparticles
Circumferential (4 times) 1mL into submucosa
Distal to lesion
89
Vagal response to colonoscopy
Cessation of scope movement
IVF
90
Lipoma
No need for resection
Yellow bulge into lumen with mucosal covering
91
Colitis?
Biopsy
92
Angiodysplasia
Most common in right colon
If no bleeding no therapy needed
93
Perforation: Colonoscopy
Scope torquing
High air pressure
Blow out of diverticulum
Location: Rectosigmoid
94
Trend in mucosal ischemia
White -> Green -> Black
95
Scope with side view
Duodenoscope
Allows for visualization of duodenal strictures
Must loop along greater curvature of stomach to enter pylorus
Blind advancement into esophagus (Maintain center to avoid injury)
96
External source of illumination
Xenon arc
Halogen filled tungsten filament lamp
LED
97
Combination of button and scope channel
Blue: Air (Hover)/Water (Press)
Red: Suction & Biopsy
98
If no irrigation channel
Use suction/biopsy
99
How many wheels does a scope have
Two wheels
100
Brush biopsy detection rate
30-60%
| Higher than FNA
101
Indications for biopsy in ERCP
Ductal pathology: Ampulla/ductal biopsy
Chronic pancreatitis
Pancreas divisum
Malignany
Strictures
Ductal Injury
Jaundice
Cholangiitis
Gallstone pancreatitis
Ductal dilation
102
FNA detection rate
6-30%
103
Technique: Sphincterotomy
11 O'clock on ampulla
Blend setting
15-20 J
104
Higher risk of post procedural pancreatitis
3-5%
Endoscopic balloon dilation
105
Stone removal: Balloon
Good: Multiple stone removal
Bad: Small stones in large duct, sharp stones
Adverse effect: Post procedural pancreatitis
106
Stone removal: Basket
Good: Large stone
Intrahepatic stones
Small stones in large ducts.
107
Large stone
Stent (plastic) and repeat ERCP
108
Biliary stent
Patency: 3-6 months
Replace if clogged (Higher pancreatitis rate 3-6 months)
Placed across ampulla
109
Pancreatic stent
Patency: 3 weeks
Risk of damage to pancreatic duct
110
Self expanding metal stents
Longest patency rates (Especially if covered)
Palliation/Malignant obstruction
111
Nasobiliary tube
Good: Does not need repeat endoscopy for removal
112
Contraindication: ERCP
Absolute: None
Relative: Coagulopathy
HD instability
Pregnancy
Severe gastritis
Duodenal strictures
113
Antiplatelets
Hold 10 days prior
Hold 5-7 days post procedure
114
Warfarin
Hold 5 days before procedure
Transition to Lovenox
Hold Lovenox 1 day prior to procedure
115
Technique: Intubating duodenum with Duodenoscope (side viewing scope)
Turn tip to right
116
Location of major papilla in D2
1-2 O’clock
117
Pancreatic duct cannulation in ampulla
1-3 O’clock
118
CBD cannulation in ampulla
11-12 O’clock
119
Post ERCP Risk reduction
Indocin 100 mg
Selective cannulation with guidewire prior to contrast
Stent pancreatic duct if CBD cannulation was difficult
Limit contrast in pancreatic duct
120
Risk factors for post ERCP cholangitis
Manipulation
Contrast in the biliary tree that was not fully decompressed
121
Duodenal stricture preventing ERCP
Dilate with forward viewing scope —> repeat ERCP
122
Perforation of Biliary tree
0.5%
Transpapillary & Transbadominal drainage
Avoid surgery in the acute period
123
Duration of post procedure bleeding
2 Weeks
Most common: Immediately or when eschar sloughs (7-8 days)
Snare cautery
Repeat thermal therapy is not advised
124
Risk factor for rebleeds
Active bleed
Visible vessel
Red/Dark/White maturing clot
Ulcer >2 cm
Age >60
Comorbidities
Shock
Coagulopathy
Anemia
125
Bleeding risk factors mandating endoscopic intervention
Active bleed
Visible vessel
126
Risk factor for perforation when achieving hemostasis
Repeated use of Thermal energy
Can occur up to 2 weeks post procedure.
Delayed recognition leads to heightened morbidity & mortality
127
Improve visualization during bleeding by
Lavage
Irrigation
Clot removal via position change
128
Warm fluid
Prevents hypothermia and cogulopathy
129
Larger caliber evacuation tubes
Edwald - Used for lavage
130
Gastric motility agents to allow for blood passage
UGI Bleed: Erythromycin, Reglan
LGIB: Polyethylene glycol
131
Nonthermal Technique for hemostasis
Submucosal injection
Band ligation
Endoscopic clips
Endoloop
Balloon tamponade
132
Band ligation complication (Esophageal varices, internal hemorrhoids)
Esophageal ulceration
Stricture formation
Less complications than sclerotherapy, same level of success
Poor visualization during banding
133
Submucosal injection
Epinephrine (1:10,000) +/- Sclerosant solution
134
Endoscopic clip
When thermal energy use is dangerous or has been unsuccessful.
Lower rate of success
Difficult in post pyloric bulb or requiring retroflexion (fundus, cardia)
Location: Thin walled areas
135
Balloon Tamponade
Endoscopic sphincterotomy
Risk of overinflation and tearing
136
Coaptive Hemostasis
Probe - Tamponade + Thermal energy
Occluding vessel via pressure from multipolar probe and applying energy
Decreases heat sink effect
Better visualization
Size limit: 2 mm
137
Bipolar & Heater probe
Most common
Allow use of irrigation
Sizes: 2.3 mm & 3.2 mm -- Larger sizes require therapeutic channel
Deeper areas
138
Monopolar cautery
Higher risk of full thickness injury
Deeper areas
139
Variables in probe success
Probe size
Force of application
Power setting
Duration of energy delivery
140
Argon plasma coagulation (APC)
Advantage: Does not dislodge clot
Superficial (Palliative, Cleaning up)
Broad areas [Gatric antral vascular extasis (GAVE)]
Thin areas [Cecum]
Disadvantage: High perforation risk
No tamponade effect
Cannot reach deeper
141
Cold biopsy
Spiked forcep - Allows for multiple specimens in a single pass without tissue loss
142
Colonic gas
Replace colonic gas with air to decrease amount of flammable gas
143
Resective Technique
1. Snare polypectomy
2. Transection
144
Snare polypectomy
Pedunculated polyp
Pull polyp away from bowel, broad contact
145
Transection
Short monopolar bursts -> Tighten snare
146
Polyp retrieval
Small: Suction into trap
Large: Suction into tip w/ scope withdrawal
Retrieval net
Lost polyp: Stool straining
147
Sessile Polyp
1. Elevate submucosa w/ saline/hyaluronic acid
2. Place snare around lesion
3. Suction polyp into port to raise it
*Need two-channel therapeutic endoscopes
148
Failure of sessile lesion to rise with saline injection
Involvement of submucosa
Endoscopic resection not advisable
149
Safe excision needed for (raised base with saline)
1. Larger sessile polyps
2. Angulated portions of intestinal tract
3. Thin walled areas of colon (cecum)
150
Piecemeal Excision
1. Polyp stalk >2-2.5 cm
2. Polyp base >1-1.5 cm
151
Safe areas to perform multiple snare excisions
Thicker or extraperitoneal areas
(Rectum)
152
Periampullary duodenal adenoma excision
Consider biliary & pancreatic duct stenting
153
Post polypectomy syndrome
Focal pain and tenderness without free air or exravasation on imaging
Treatment: Bowel rest & antibiotics
154
Sampling technique
1. Cold biopsy
2. Spiked biopsy forcep
3. Hot biopsy
4. Brush cytology
5. Repetitive biopsy (Required therapeutic endoscopy with 3.7 mm port)
155
Submucosal Pathology
Requires endoscopic ultrasound (EUS) and dual channel therapeutic endoscopy to delineate bowel wall depth
156
Enhanced visualization
Chromoscopic, spectroscopic, and magnification techniques
157
Lugol solution (1-2%)
Stains glycogen containing normal esophageal squamous mucosal cells
158
Methylene Blue (0.5-1%)
Stains intestinal absorptive epithelium
Identifies areas of intestinal metaplasia and focal carcinoma
159
Spectroscopy
Distinguishes dysplastic and malignant cells from benign epithelium
Narrow bandwidth imaging defines differences in tissue vascularity
160
Magnifying Endoscope/ Chromoscopes
Delineates mucosal crypt architecture
Risk of more advanced colonic neoplasia (delayed diagnosis)
161
Nd:YAG
Deep areas of hemostasis
162
Alcohol injection
Inexpensive ablative therapy
Unpredictable depth of infiltration
163
Photodymanic therapy
Protoporphyrin derivative (porfimer sodium) compound injected IV and concentrates within neoplastic tissue
Wavelength laser light deployed causing photochemical reaction to porfimer sodium leading to production of singlet oxygen and targeted cell death
Advantage: Barrett's ablation (Dysplastic)
Palliative therapy (esophageal carcinoma)
164
Percutaneous Endoscopic Gastrostomy (PEG)
Indications:
1. Functioning GI tract but cannot take enteral feeds
2. Gastric decompression
3. Gastropexy for volvulus reduction
Contraindication:
1. Massive ascites
2. Diffuse gastric cancer
3. Distal obstruction
Relative: Threat to pulling out tube
165
Percutaneous Endoscopic Jejunostomy (PEJ)
1. Gastroparesis
2. Atony
3. Functional GOO
4. Reflux/aspiration
166
Pull Technique (PEG)
Attach pull PEG at oral end of guidewire
Pull retrograde through mouth
Secure PEG with bumper
167
Replacing PEG & PEJ
When no longer functional
168
PEG leaks
Loosen PEG, prevent movement
169
GC fistula
If early, operative closure
170
PEG dislodged w/ peritonitis
OR
Closure of track
Place tube elsewhere
171
Push Technique (PEG)
Advance PEG over stiff nonlooped wire
Secure external bumper
172
Russel Approach (PEG)
*Patients with laryngeal/esophageal carcinoma*
Avoids seeding cancer
Stomach held up by T fasteners
Needle -> Dialator -> Balloon tipped catheter
173
PEJ Placement
Pediatric colonoscope
Small G tube
Fluouroscopy
174
Dilations
Do not dilate beyond 3 sequential bougie sizes
175
Dyphagia relieved at what bougie size
40F
176
Where can objects not be retrieved endoscopically
Treitz to Treves (IC valve)
177
Stones in common hepatic duct proximal to cystic duct
Choledocotomy
178
Stone removal on IOC
1. Saline flush
2. Glucagon to flush through Oddi
3. Basket or forcep
179
Foreign body amenable for removal
1. In esophagus
2. Irregular and in stomach
3. Rectum or sigmoid
180
https://img.medscapestatic.com/pi/meds/ckb/43/35343tn.jpg
Barrett's Esophagus
181
https://www.researchgate.net/publication/319412550/figure/fig1/AS:533599172923392@1504231364579/Endoscopy-revealed-an-esophageal-perforation-in-the-left-side-of-the-upper-thoracic.png
Perforation
182
https://img.medscapestatic.com/pi/meds/ckb/88/35688tn.jpg
Gastric ulcer
183
https://www.gastrotraining.com/wp-content/uploads/2010/07/image00110.jpg
Zenker Diverticulum
184
https://journal.medizzy.com/wp-content/uploads/2022/06/imageXml-2.png
Hiatal Hernia
185
https://www.endoscopy-campus.com/wp-content/uploads/2016/07/Grad_II_Bild1.jpghttps://www.endoscopy-campus.com/wp-content/uploads/2016/07/Grad_II_Bild1.jpg
Esophageal varices
186
https://f6publishing.blob.core.windows.net/cdc8fdfa-78d9-4514-b143-bf5b514b534d/WJGE-2-252-g003.jpghttps://f6publishing.blob.core.windows.net/cdc8fdfa-78d9-4514-b143-bf5b514b534d/WJGE-2-252-g003.jpg
Esophagitis
187
http://3.bp.blogspot.com/-lMaa7zKBbIk/Teqb96ej_gI/AAAAAAAACkY/8JdM77nHCvs/w1200-h630-p-k-no-nu/schatzki_ring.jpg
Schatzki Ring
188
https://upload.wikimedia.org/wikipedia/commons/4/49/Endoscopic_view_of_fundic_gland_polyps.jpg
Fundic gastric polyp
189
https://img.medscapestatic.com/pi/meds/ckb/65/291065tn.jpg
Gastric adenocarcinoma
190
https://www.researchgate.net/publication/283184318/figure/fig4/AS:614032855797775@1523408249679/Colonoscopic-images-of-hypertrophic-Peyers-patches-in-the-terminal-ileum_Q640.jpg
Peyer's patches in terminal ileum
191
https://upload.wikimedia.org/wikipedia/commons/thumb/a/a5/Argon_plasma_coagulation.jpg/300px-Argon_plasma_coagulation.jpg
Angiodysplasia
192
https://study.com/cimages/multimages/16/cc463b5c-0d7e-4127-8929-116b6776fc4d_intestinal_ulcer.jpeghttps://study.com/cimages/multimages/16/cc463b5c-0d7e-4127-8929-116b6776fc4d_intestinal_ulcer.jpeg
Sterocoral ulcer
193
https://media.sciencephoto.com/c0/16/67/21/c0166721-800px-wm.jpg
Crohn's Colitis
194
https://www.gastrointestinalatlas.com/imagenes/UlcerativePseudoPolipois4.jpg
Ulcerative colitis
195
https://static-02.hindawi.com/articles/grp/volume-2013/192794/figures/192794.fig.001d.jpg
Radiation enteritis
196
https://www.bmj.com/content/bmj/355/bmj.i6600/F3.large.jpg
Ischemic colitis
197
https://healthjade.com/wp-content/uploads/2018/03/Pseudomembranous-colitis.jpg
C diff
198
https://www.researchgate.net/publication/346919088/figure/fig5/AS:1022616718540809@1620822233607/Endoscopic-signs-of-colonic-lipoma-including-A-pillow-sign-and-B-naked-fat-sign-with.jpg
Lipoma
199
https://www.frontiersin.org/files/MyHome%20Article%20Library/973883/973883_Thumb_400.jpg
Melanosis coli
200
Forrest Classification
Bleeding ulcers
201
Hill Grade
Hiatal hernia
I: Ring of tissue around scope
II: Widening of angle of his
III: Lumen does not close around scope
IV: Hiatal hernia present at all times, sphincter axial
202
Los Angeles
Reflux esophagitis
A-D
203
Prague
Barrettes' Esophagus
204
Right combination of button and channel
Suction + Biopsy
205
No channel for irrigation
Suction + Biopsy channel
206
Point to discuss in informed consent
Complications
207
Preparation: Sigmoidoscopy
Enema
208
High bleeding risk procedure
Esophageal dilation
209
Request anesthesiologist specialist
Increased risk of complications due to comorbidities
210
Boston bowel prep classification
Bowel prep classification
211
Enteroscopy
Double balloon - Gold standard
212
Scope: Proximal jejunum
Pediatric scope
213
Complication: Billroth II
Pancreatitis
Perforation
Retrograde access via distal duodenum
214
ERCP: Billroth II
Retrograde access from distal duodenum
215
Indication: Sphincterotomy
Leaks
Obstruction
Stent placement
216
Post sphincterotomy bleeding
Thermal & Endoclips
217
ERCP Anatomy
CBD = Parallel to duodenum
Pancreatic duct = Perpendicular to duodenum
Minor papilla: Proximal to major papilla. Harder to intubate
218
Cytology
When tissue removal is not needed
Esophageal candidiasis
219
EUS Probe type
Curvilinear
220
Biopsy on EUS can be taken up to the
3rd level of mucosa
1st: Superficial mucosa
2nd: Deep mucosa
3rd: Submucosa
221
EUS/FNA Post procedure pancreatitis
<2%
222
Lymph node anatomy
Benign: Triangular
Malignant: Hypoechoic
Size > 1cm
Irregular borders
223
Magnification on standard high resolution endoscope
30x
224
Magnification of zoom endoscope
150x
225
High definition scope detects dysplasia
3 fold
226
NICE classification
Hyperplastic: Lighter/Same as background
Adenoma: Browner than background
Invasive cancer: Dark brown, patchy white
227
NBI zoom detects dyplasia in Barrett's: sensitivity & specificity
95%
228
DISCARD Trial
If NBI used, pathology is not needed for polyps <10 mm
229
Technique: Distal duodenum
Torque clockwise
230
Technique: Incisura
Torque ounterlockwise
Withdraw - See body & Cardia
Rotate endoscope 360 at GE junction
231
Technique: Rectum
Flex tip
Bypass canals
20 cm
232
Rockball Score
Likelihood of death with GIB
