Endoscopy
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Updates in Advanced Endoscopy and Intraluminal Surgery
Endoscopy- Key Concepts
- Summary
- References
- Introduction
- Anorectal Examination
- Endoanal/Endorectal Ultrasound
- Flexible Endoscopy Techniques
- Flexible Sigmoidoscopy
- Colonoscopy
- Bowel Preparation
- Special Considerations
- Sedation
- Instrumentation
- Colonoscopy Technique
- Alternative Techniques
- Carbon Dioxide Insufflation
- Water Insufflation
- Chromoendoscopy
- Narrow Band Imaging
- Full-Spectrum Endoscopy
- Difficult Exams
- Incomplete Colonoscopy
- Complications
- The Endoscopy Unit
- Training and Simulation
Perioperative- A 54-year-old woman presents 6 months after a sigmoid partial colectomy performed for diverticular disease. She describes increasing symptoms of abdominal pain, constipation, and cramping. Endoscopy shows narrowing at the level of the colorectal anastomosis (see figures below). The most appropriate next step in management is
- During an investigation of an infection outbreak in your endoscopy unit, you are worried about the role of biofilm. What step is critically important to be performed in a timely fashion during the processing of flexible scopes to prevent the formation of a biofilm?
- Benign Disease
- For quality assurance of the completeness of a colonoscopy, it is mandatory to achieve which of the following?
- A 75-year-old man with no significant medical history presents to the emergency department with recurrent bright red blood per rectum. Previous workup included computed tomography angiography (CTA), upper endoscopy, and anoscopy, which were all negative. Previous colonoscopy showed pancolonic diverticulosis with blood throughout the colon. He is now receiving his fifth unit of packed red blood cells. His blood pressure remains 80/50 mmHg despite resuscitation. What is the best next step in this patient’s management?
- A 45-year-old man has an 8-year history of moderate-to-severe chronic ulcerative colitis (UC), managed with biologics and with good symptom control. He has no other notable medical or surgical history. His last colonoscopy was performed 1 year ago, with random biopsies demonstrating low-grade dysplasia. The patient is concerned about the development of colorectal cancer due to his history and is here for surveillance endoscopy. What is the best next step in this patient’s management?
- A 36-year-old patient with ulcerative colitis (UC) underwent total proctocolectomy with ileal pouch anal anastomosis (IPAA) 3 years ago. The patient presents now with lower abdominal discomfort that is associated with bloody loose stools. Endoscopy shows erythematous friable rectal cuff with deep ulcers. The rest of the pouch appears normal. What is the most appropriate treatment?
- Pelvic Floor
Benign Disease- A 44-year-old man with known stricturing gastroduodenal Crohn’s disease with prior dilations who is receiving maximal medical therapy is admitted for increasing upper abdominal pain, nausea, vomiting, and weight loss. On endoscopy, obstructing duodenal stricture is noted. The esophagogastroduodenoscopy scope could not traverse this area. After nasogastric decompression, his best treatment option is:
- A 65-year-old man receiving long-term nonsteroidal treatment for arthritis presents to the emergency department with brisk bright red rectal bleeding and a blood pressure of 90/40 mm Hg. Intravenous fluid resuscitation has started. What is the best next step in evaluating the bleeding source?
- A 75-year-old woman without a history of liver disease or anticoagulant use is admitted to the intensive care unit with lower gastrointestinal bleeding. Findings of computed tomography angiography of the abdomen and pelvis and upper endoscopy are negative. Colonoscopy shows blood throughout the colon, but was unable to localize a definite source. A colonoscopy report from 3 years ago shows a 5-mm ascending colon tubular adenoma and sigmoid diverticulosis. In the past 48 hours, she has required transfusion of 6 units of packed red blood cells for ongoing bleeding. Digital examination and anoscopy show no significant anorectal pathology. The patient is hypotensive, requiring 2 vasopressors, and with tachycardia to 115 beats/min. What is the best next step in management?
- A 65-year-old man presents with abdominal pain, 15-lb (6.8-kg) weight loss, rectal bleeding, diarrhea, and joint pain. He had recently started taking prednisone for rheumatoid arthritis. On endoscopy, he is noted to have mucosal friability and ulcerations with pseudopolyps in the descending colon with rectal sparing. His terminal ileum is normal. Which finding is associated with a diagnosis of Crohn’s disease?
- A 30-year-old woman with a history of perianal Crohn’s disease has had a seton in place for transsphincteric fistula for the past 2 months. She is also taking infliximab for medical management of her Crohn’s disease with no active proctitis seen on recent endoscopy. Ultrasonography shows 50% involvement of the sphincter complex with no undrained abscess or high blind tracts. What is the most appropriate management approach for her fistula?
- A 70-year-old man underwent external beam radiation for prostate cancer 2 years ago. He now presents with several episodes of bright red blood per rectum. Endoscopy reveals diffuse telangiectasias throughout the rectum. What is the next step in management?
- The quality metric for endoscopists that highly correlates with reduced interval colon cancer incidence and death is:
- Malignancy
- A 60-year-old patient undergoes an average-risk screening colonoscopy and is found to have a large sessile polyp on the left colon. What methods can you employ to evaluate the morphology of the lesion and its risk of harboring malignancy?
- A 78-year-old woman with coronary artery disease and congestive heart failure presents with symptoms of large bowel obstruction. Computed tomography (CT) shows a large obstructing descending colon mass with numerous hepatic and pulmonary lesions suggestive of metastatic disease. There is no evidence of bowel perforation or ischemia. Flexible endoscopy shows a large near complete obstructing carcinoma in the descending colon. Which of the following is the most appropriate next step?
- Malignancy
- Lower Gastrointestinal Hemorrhage
- Endoscopic Management of Polyps and Endoluminal Surgery
- Perioperative
- Management of Malignant Polyps
- IBD Diagnosis and Evaluation
- The Emergence of Artificial Intelligence in Surgery: Will machine learning lead to the next big disruption in practice and training?
- Rectal Cancer: Nonoperative Management
- Gastrointestinal Stromal Tumors, Neuroendocrine Tumors, and Lymphoma
- Complications of the Pelvic Pouch
- Management of Complex Colorectal Polyps