Practical Gastrointestinal Endoscopy

Practical Gastrointestinal Endoscopy: The Fundamentals, Fifth Edition
Peter B. Cotton, Christopher B. Williams
Copyright © 2003 by Blackwell Publishing Ltd
37
Diagnostic Upper Endoscopy
4
Techniques
Details of patient preparation are given in Chapter 3, along with
some broad categories of indications. Clearly, both the endoscopist
and the patient must be confident that the procedure is
likely to be worthwhile and that it will be performed skillfully,
with appropriate equipment and assistance.
PATIENT POSITION
The patient lies on the examination trolley/stretcher on the
left side with the intravenous access line in the right arm. The
height of the stretcher may be adjusted for comfort. The patient’s
head is supported on a small, firm pillow, so as to remain in a
comfortable neutral position (Fig. 4.1). Monitoring devices are
attached and supplemental oxygen may be given, usually via
nasal prongs. Necessary sedation and/or pharyngeal anesthesia
is applied. A biteguard is placed.
ENDOSCOPE HANDLING
The endoscopist should stand comfortably facing the patient,
holding the instrument so that it runs in a gentle curve to the
patient’s mouth (Fig. 4.2).
The control head of the endoscope should be placed in the
palm of the left hand, and held between the 4th and 5th fingers
and the base of the thumb, with the tip of the thumb resting on the
up/down control (Fig. 4.3). This grip leaves the 1st finger free to
activate the air/water and suction buttons. The 2nd finger assists
the thumb as a helper or ‘ratchet’ during major movements of
the up/down control. With practice, the left/right control can be
managed also with the left thumb (Fig. 4.4). Twisting the control
body applies torque to the straightened shaft and is an important
part of steering.
The righthand is used to push and pull the instrument, to apply
torque rotation and to control accessories such as biopsy forceps.
PASSING THE ENDOSCOPE
Check that the patient is stable and comfortable and that the assisting
nurse is ready. Select a standard forward-viewing endoscope
and check it. Perform a white-light balance, lubricate the
distal tip and double check the critical functions:
• tip angulation;