Good day, and Welcome to Medicine with Dr. Moran. I'm Dr. Keith Moran. Today I've
got an intriguing video for you. It's all about upper GI tract endoscopy otherwise
known as gastroscopy. We're going to review the procedure itself, some of the
preparation, the anatomy in particular, and at the end there will be a
full-length video so that you can see exactly what I see when I do the
procedure. Let's get started. I'm going to show the anatomy so that you understand
what we're doing when we do an upper GI tract endoscopy. Essentially, we look at
the upper airway, the esophagus, the stomach, and the first part of the
duodenum. The endoscopy is often called by other names such as a gastroscopy
although that's less specific because gastro indicates stomach and
we're scoping more than just the stomach. In England it's often called an OGD the
o is for esophagus with the English spelling G for gastro and D for duodenum
so esophagogastroduodenoscopy which is quite a mouthful. The procedure
itself one needs to prepare for nothing to eat in terms of solid food for 8
hours before the procedure. You can have clear fluids up to 2 to 3 hours
before the procedure. The majority of my patients have it done with some sedation
but it can be done with just simply local freezing spray to the upper airway.
Approximately 30 to 50 percent of my patients have it done that way. Next, I
want to show the anatomy. I'm going to rotate the manikin here because we start
at the teeth and the lips the scope is advanced over the top of the tongue. This
is the tongue here and it's angled downwards to go to the back of the
throat. Now the esophagus is a posterior
structure meaning it's towards the back and this the entrance way where
my finger is to go in there. You will see there's a yellow structure here a little
flap that's called the epiglottis. That epiglottis or flap will fold down and
cover the vocal cords which is just below it so that when you swallow food
the food doesn't go down the wrong way, the food will be guided into the
esophagus. Now I want to show you where the esophagus is once we pass this
section and to do that I have to get rid of some of the organs and the reason is
is it's a posterior structure so I'm going to remove the lungs and then I'm
going to remove the heart. Now you can see posteriorly this brown structure it
looks like a tube and it's the esophagus. It starts about 20 centimeters from
the lips and it goes all the way down to the bottom part where it joins the
stomach right here at 40 centimeters again a distance from the lips. The
esophagus is circular and it's like a tube and it transports the food down. You
will see on the video that I'm about to show some peristaltic waves which are
waves of contraction. This is a muscular organ that contracts to squeeze to push
the food down into the stomach. Now at the end of the esophagus in this light
blue color going from one edge of the body all the way to the center and then
again across here is the diaphragm. It's a big muscular structure and it
has a hole in it that the esophagus goes through and that's
called a diaphragmatic hiatus. Now I'm going to remove the liver. The liver is in
brown here, so that you can see the stomach. This is the stomach. I'm going to
remove it here for a minute so you can see it. The junction between the stomach
and esophagus is right here at the diaphragm and you will see on the video
that the lining looks different and that's because they're different cells
that line the stomach compared to the esophagus. The stomach is an organ
which secretes acid to help digest and break down the food into smaller
components so that it can leave the stomach through the end of the stomach
where there's an opening called the pylorus. The food will
then go down there into this section which is the small intestine. The first
section of the small intestine has a special name it's called the duodenum. Now you'll
notice that the stomach has a particular shape to it part of the stomach sits up
high here this part is called the fundus and it's hard to see that part with the
scope. The scope has a camera on the end that looks forward so when you're
looking forward and the scope is here you're not going to see this section and
so when we do the scope when you see the video you will see that I perform a
maneuver which we call retroflexing the scope where we bend it on itself and
basically get turn it into a J. So the scope comes down and then it twists like
a big hook and looks back upon itself so that we can see this section in here
because this is poorly seen if we just put the scope down forward viewing. Now
the small intestine. This is the beginning and it turns to go down
further into the abdomen and this is the entire small intestine here which
ultimately joins with the large intestine which is in blue. The small
intestine is this pinkish color and the large intestine which is also known as
the colon is actually in blue and the colon starts here. There's a
separate video on my channel about colonoscopy that will go over the anatomy and there will
be nice video on a colonoscopy so you can see what that's like if you're
having one done but the colon. There's a section called the ascending
colon. This section is called the transverse colon because it goes across
the abdomen in a transverse fashion and then down into the descending colon here
and the decending colon ultimately turns into the sigmoid
colon, then the rectum, and then the bowel contents come out through the anus.
I am now going to show you what an upper GI tract endoscopy looks like from my
perspective. We're starting in the mouth here the white arrow points towards the
tongue and the black arrow is showing the route down into the throat area. As
you can see, I'm angling down and the black arrow is now pointing to the uvula.
That's the part that hangs down that you can see when you open your mouth and the
white arrow shows the epiglottis. Looking further down the vocal cords have
pointed out by the white arrow and the route down into the esophagus is pointed
by the black arrow. There's some secretions or bubbles that you can see
which are white in this picture. Now I'm going to slide along the posterior wall
of the posterior part of the pharynx and popped through the upper esophageal
sphincter there which you can see contracting. I'm now advancing the scope
down into the esophagus. The esophagus is 2 centimeters in diameter
to give you a size comparison. You can see see waves of contraction. I'm now down in
the lower esophagus and you will see the junction between the esophagus and the
stomach. The white arrow is pointing to that junction the black arrows pointing
towards the hole that will take us into the stomach. The folds of the stomach you
can see just above the black arrow. We often call this the gastroesophageal
junction. You'll see the difference in lining between the esophageal lining and
the stomach lining. The esophageal lining is a pink grey mucosa now going down
into the stomach. I'm putting CO2 in to distend the stomach.
I'm making a turn to the right, there's some liquid in the bottom
of the stomach there as you can see. Which is the green greenish yellow liquid.
There's a number of bubbles here and I'm wiping my screen here you'll see flashes
of water coming across the screen. That's the end of the stomach there. That little
hole is called the pylorus which is a muscular opening
which when it opens will let the scope pop into the duodenum, the first part of
the intestine which I'm now in and we are now down into the duodenum and the
scope will be advanced down the duodenum.
The duodenum is the first part of the small intestine. You can see I'm rotating
the scope around here and angling the scope upwards. The mucosa is glistening
here you'll see me wipe the screen with water.
Now here I'm pointing out the villi the villi look like finger like projections.
90% of the digestion absorption of food come in through the small intestine.
These are one cell thick lining and the villi give additional mucosal surface in
order for the food to be absorbed. Often they're easiest to see when there's some
liquid on top and that's why you see the yellowish liquid that's on top that
allows you to see it. Some people say it looks like a shag carpet!
Now, I'm withdrawing the scope here and as I withdraw the scope it falls back
quickly into the stomach which often is the case and then you have to advance it
back into the duodenum. This video is edited, I've taken some sections out, but
it gives you a good idea of what the duodenum looks like. Now we're in the
stomach you'll see the stomach's red there's some red linear markings that
that arrows pointing to there's very mild stomach inflammation which was
confirmed on biopsy in this particular case. There's many different causes for
stomach inflammation. The purpose of the stomach is to store food it's also to
grind the food down and to mix the food by secreting acid primarily their
muscles in the stomach that help contract to grind the food down. Here I
am taking biopsies of these areas that are reddened.
You can see those red lines again in the stomach.
The stomach really is a storage reservoir for food in order for the food
to get broken down. I'm taking some initial additional rather biopsies from
the stomach we often take two from the end of the stomach, two from the area we
just took from, and then the final two will be from what we call the body of
the stomach. You're looking at the body of the stomach there and the way we know
that is that we can see folds. You will see folds in this part of the stomach
which you can see along the bottom surface here where the biopsy forceps is
going into. These biopsies are painless so if you're having an upper GI tract
endoscopy done without sedation this does not hurt. I'm now going to retroflex
the scope, so you can see the scope in the foreground and I'm going to rotate
the scope around so that I can look into the upper part of the stomach which we
call the fundus. I'm adding some CO2 to distend this area and at the same
time I'm suctioning that liquid.
Again you can see the black scope in the foreground with the white line marking
which gives us an idea of how far in the stomach where you are. Once we've had a
good look at the duodenum in the stomach we withdraw all of the CO2, carbon dioxide, that's
in the stomach which I'm doing. You can see it collapsed now the stomach is
collapsing. I'm withdrawing the scope. and there's a small amount of blood you see.
You're talking about a drop or two in those biopsy sites at the absolute most.
Now I'm withdrawing the scope so that we're going to come back to the gastro
esophageal junction which we saw on insertion and you can see the transition
of the lining here from the salmon pink colored mucosa of the stomach to the
whitish gray mucosa of the esophagus. I'm taking a biopsy here at the
gastroesophageal junction. Again these are painless biopsies. This particular
patient had a slightly irregular GE junction with a fold of mucosa which
I've just biopsied a little bit higher than the rest of the GE Junction. We're
taking these biopsies to see if there's inflammation from acid coming back up
into this region causing inflammation of the distal or the end of esophagus which
we called esophagitis and that's secondary to gastroesophageal reflux disease. At
this point, I'm withdrawing the scope and you can see the mucosa of the esophagus.
We come back slowly to look for any pathology here in the esophagus. Now I'm
coming through the upper esophageal sphincter. I've just come through it
there and now I am sitting just behind the vocal cords. You can see the vocal
cords pointed out in white. There's a left and a right and the black arrow is
pointing to where we have just been. When we intubate somebody and put them on
life supports we put a tube between those vocal cords right in the middle of
the screen to ventilate the lungs. I'm sucking out some of the secretions that
sometimes pool in that region. Now you can see the way the vocal cords move. I
hope you enjoyed this look. An exciting look in fact into the upper
gastrointestinal tract with me today. I hope you found it educational and
informative. Thank you for watching Medicine with Dr. Moran. I'm Dr. Keith
Moran. Please feel free to leave a comment about what you saw today.