Читать книгу Practical Pediatric Gastrointestinal Endoscopy - Группа авторов - Страница 4

1 Chapter 10Figure 10.1 Suggested diagnostic algorithm of chronic vomiting. PPI, proton ...Figure 10.2 Suggested diagnostic algorithm of lower gastrointestinal bleedin...Figure 10.3 Suggested diagnostic algorithm for chronic abdominal pain.Figure 10.4 Suggested diagnostic algorithm of chronic diarrhea.Figure 10.5 Suggested initial management of upper gastrointestinal bleeding....

2 Chapter 11Figure 11.1 Control panel handling. The control panel is held by the left fo...Figure 11.2 The connecting tube behind the thumb balances the weight of the ...Figure 11.3 Manipulations with the R/L and U/D knobs. The thumb is the main ...Figure 11.4 Technique of extensive rotation of the control knobs. The middle...Figure 11.5 The initial phase of esophageal intubation. The endoscopist shou...Figure 11.6 The root of the tongue appears as a cobblestone texture. It may ...Figure 11.7 The initial view of the epiglottis. The epiglottis should be fou...Figure 11.8 The endoscopic anatomy of the larynx: panoramic view.Figure 11.9 Endoscopic appearance of the vocal cords. A close capture of the...Figure 11.10 Close‐up view of the crico‐arytenoid cartilages. The esophageal...Figure 11.11 Side‐view of the groove between the lateral wall of the larynx ...Figure 11.12 Appearance of the pharyngoepiglottic fold signals to reverse di...Figure 11.13 Close‐up view of the esophageal orifice.Figure 11.14 The second physiological narrowing of the esophagus. It does no...Figure 11.15 The distal esophagus. It tapers down toward the hiatal notch.Figure 11.16 Z‐line. The junction between the pale esophageal and richer col...Figure 11.17 Prominent fold of the greater curvature of the stomach. Appeara...Figure 11.18 Panoramic view of the gastric body. It can be achieved by clock...Figure 11.19 Gastric angularis. The detailed image of the angularis can be e...Figure 11.20 Panoramic view of the antrum. At this stage of the procedure, t...Figure 11.21 Panoramic view of the duodenal bulb. This is useful for correct...Figure 11.22 Endoscopic mapping of the duodenal bulb during the insertion ph...Figure 11.23 Mapping of the walls of the duodenal bulb after reduction of th...Figure 11.24 Appearance of the transitional zone between the duodenal bulb a...Figure 11.25 Horizontal configuration of the transitional zone between the d...Figure 11.26 The major duodenal papilla, the hallmark of the second portion ...Figure 11.27 The major duodenal papilla. The side‐viewing duodenoscope allow...Figure 11.28 The endoscopic appearance of the duodenum at the level of the l...Figure 11.29 View of the gastric body during the initial phase of the retrof...Figure 11.30 Appearance of the cardia after partial withdrawal of the shaft ...Figure 11.31 Detailed view of the cardia after further withdrawal of the sco...Figure 11.32 Appearance of the Z‐line signals the end of the withdrawal part...Figure 11.33 Small squamous papilloma of the middle esophagus.Figure 11.34 (a) Proximal edge of almost circumferential mass in the distal ...Figure 11.35 Highly unusual appearance of the gastric mucosa: prominent and ...Figure 11.36 (a) Acute phase of severe corrosive gastritis. (b) Multiple sca...Figure 11.37 Pinpoint narrowing of the pylorus induced by the circular mass ...Figure 11.38 Heterotopic pancreas in the greater curvature of the prepyloric...Figure 11.39 (a) Sessile hyperplastic polyp in the antrum. (b) Inflammatory ...Figure 11.40 Burkitt’s lymphoma: multiple ulcerated mass lesions in the stom...Figure 11.41 Razed, rounded ulcerated lesions with irregular base in the sto...Figure 11.42 (a) A relatively large active ulcer on the posterior wall of th...Figure 11.43 (a) Edematous and dilated folds of the duodenum. (b) Numerous w...

3 Chapter 12Figure 12.1 Unusually wide‐open anus. This finding is suspicious for spina b...Figure 12.2 Squamocolumnar junction or dentate line.Figure 12.3 The longitudinal folds in the distal rectum (columns of Morgani)...Figure 12.4 Semilunar folds of Houston in the rectum.Figure 12.5 Typical vascular pattern of the normal rectum.Figure 12.6 The sigmoid colon. The endoscopic markers of normal sigmoid colo...Figure 12.7 The angle is sharper when the descending colon extends down belo...Figure 12.8 The descending colon. The shape of the descending colon is close...Figure 12.9 The vascular pattern of the descending colon. The stems of the v...Figure 12.10 The splenic flexure. It is marked by bluish discoloration.Figure 12.11 The angle between the splenic flexure and transverse colon in r...Figure 12.12 The transverse colon. The triangular shape is the endoscopic ha...Figure 12.13 The hepatic flexure. The mucosa of this area is paler and has a...Figure 12.14 The hepatic flexure, which is dome shaped. The junction between...Figure 12.15 Appendiceal orifice and “bow and arrow sign”: the imaginary arr...Figure 12.16 A focal widening or bulging of the circular fold at the upper a...Figure 12.17 Lumen as a clock face. (a) Scope straight. (b) Tip up deflectio...Figure 12.18 Slightly depressed groove‐like area and merging folds are the s...Figure 12.19 The main submucosal veins and their branches. The main vessels ...Figure 12.20 Common locations of the lumen. (a) The lumen is located at 9 o’...Figure 12.21 Prominent taenia coli. An appearance of the taenia while approa...Figure 12.22 Schematic images of: (a) alpha loop, (b) N‐loop and (c) Scope G...Figure 12.23 Gamma loop in the transverse colon.Figure 12.24 The ileocecal valve. It is usually located between the 5 o’cloc...Figure 12.25 The terminal ileum. Velvety texture, yellowish tinge, and lymph...Figure 12.26 Ulcerative colitis. Diffuse inflammation is typical for ulcerat...Figure 12.27 The “cecal patch”: a focal inflammation of the appendiceal orif...Figure 12.28 Severe form of ulcerative colitis. (a) Narrowing of the lumen d...Figure 12.29 Multiple pseudopolyps. (a,b) Acute phase. (c) Endoscopic remiss...Figure 12.30 Aphthous ulcer. A small, 4–5 mm, shallow lesion with the rim of...Figure 12.31 Deep longitudinal ulcers in a patient with Crohn’s disease.Figure 12.32 (a) Mucosal bridging. (b) Colonic stricture.Figure 12.33 Allergic colitis. Multiple lymphoid follicles with rim of eryth...Figure 12.34 Small aphthoid‐like lesions can occasionally be induced by bowe...Figure 12.35 Numerous lymphoid follicles in the sigmoid colon.Figure 12.36 Multiple enlarged (more than 3 mm) lymphoid follicles in the te...Figure 12.37 Six‐year‐old boy with recurrent ileocolonic intussusceptions. I...Figure 12.38 Sessile juvenile polyp.Figure 12.39 Pedunculated juvenile polyp.Figure 12.40 Large juvenile polyp in the descending colon.Figure 12.41 The “chicken skin” sign. The mucosa around a large juvenile pol...Figure 12.42 Juvenile polyposis. Multiple juvenile polyps in the rectum and ...Figure 12.43 Multiple colon polyps in a 5‐year‐old boy with FAP.Figure 12.44 Adenocarcinoma of the right colon in an 11‐year‐old boy with si...Figure 12.45 Non‐Hodgkin’s lymphoma of the ileum. The indications for a colo...Figure 12.46 Langerhans cell histiocytosis of the colon: multiple yellowish ...Figure 12.47 Large hemangioma of the sigmoid colon in a 3‐year‐old girl with...Figure 12.48 Angiodysplasia of the colon in a child with recurrent low GI bl...Figure 12.49 Idiopathic colonic varices of the right colon in a 9‐year‐old b...Figure 12.50 Congenital colonic varices in a 3‐week‐old baby with hematochez...

4 Chapter 13Figure 13.1 (a) GIT biopsies embedded in multicassettes (e.g., ABC). The mac...Figure 13.2 (a) Gastrointestinal sample embedded on edge, rendering a good v...

5 Chapter 14Figure 14.1 Double‐balloon enteroscope system configuration.Figure 14.2 DBE technique.Figure 14.3 Double‐balloon tattoo.Figure 14.4 Polyp detected (a) and removed (b).Figure 14.5 Multiple angiomas in small bowel.Figure 14.6 Meckel’s diverticulum.Figure 14.7 (a) Blue rubber bleb nevus syndrome lesions. (b) Blue rubber ble...Figure 14.8 Single‐balloon enteroscopy.Figure 14.9 Spiral enteroscopy outside the patient.Figure 14.10 Spiral enteroscope advancing intraluminally.Figure 14.11 Extent of laparoscopic‐assisted enteroscopy.Figure 14.12 Intraoperative enteroscopy and transillumination of a discrete ...

6 Chapter 15Figure 15.1 Occult bleeding from an angiodysplasia.Figure 15.2 Jejunal Peutz–Jeghers polyp.Figure 15.3 (a) Crohn’s disease. (b) A follow‐up study in a 16‐year‐old male...Figure 15.4 CMUSE or diaphragm disease.Figure 15.5 Lymphoma.Figure 15.6 Meckel's diverticulum.Figure 15.7 NSAID lesions.Figure 15.8 Crohn’s aphthoid ulcers and stricture.Figure 15.9 Celiac disease.Figure 15.10 Methods of “front‐loading” the PillCam^TM onto a gastroscope. (a...Figure 15.11 Intestinal lymphangiectasia.Figure 15.12 Intestinal intussusception.Figure 15.13 Images obtained with an esophageal capsule.Figure 15.14 Colon capsule.Figure 15.15 Mechanism for magnetic capsule propulsion.

7 Chapter 16Figure 16.1 Ultrasound catheter probe.Figure 16.2 Front‐loading ultrasound probe.Figure 16.3 Radial scan ultrasound. Distal tip of echo‐endoscope with balloo...Figure 16.4 Linear scan ultrasound video endoscope. Distal tip of echo‐endos...Figure 16.5 The linear probe with advanced aspiration/biopsy needle.Figure 16.6 EUS of the needle (double arrow) advanced into a pancreatic pseu...Figure 16.7 Orientation of a FNA needle advanced through the operative chann...Figure 16.8 (a) Esophagus wall; the first inner hyperechoic (bright) layer i...Figure 16.9 Esophageal anastomotic stenosis: thickening of concentric layers...Figure 16.10 Esophageal duplication marked by arrow.Figure 16.11 Congenital stenosis with aberrant cartilaginous remnants (white...Figure 16.12 Gastrointestinal stromal tumor (GIST) (arising from submucosal ...Figure 16.13 GIST‐FNA. Arrow points toward the FNA within the labeled mass (...Figure 16.14 Gastric lymphoma (distortion of the gastric wall and enlarged l...Figure 16.15 Duodenal duplication.Figure 16.16 Plicate hypertrophy of the stomach related to Helicobacter pylo...Figure 16.17 Duodenal web.Figure 16.18 Choledocholithiasis: two stones (arrow) in the dilated common b...Figure 16.19 Autoimmune pancreatitis (white arrow pointing at fullness in pa...Figure 16.20 Pancreatic pseudocyst. (a) Hypoechoic/anechoic cyst (white arro...

8 Chapter 17Figure 17.1 The tip of a pediatric ERCP catheter pushed through the biopsy c...Figure 17.2 Endoscopic view of Barrett’s esophagus: (a) plain close view; (b...Figure 17.3 Endoscopic view of the distal duodenum in a patient with celiac ...Figure 17.4 Immersion chromoendoscopy after methylene blue spray, without pr...Figure 17.5 In a patient with familial adenomatous polyposis coli, flat (a) ...Figure 17.6 Colonic polyps before and after chromoendoscopy. (a) Hyperplasti...

9 Chapter 18Figure 18.1 Confocal laser endomicroscope (Pentax).Figure 18.2 Comparison of confocal images with conventional histological ima...Figure 18.3 Comparison of confocal images with conventional histological ima...Figure 18.4 (a) Inflammatory bowel disease showing bifid crypt pattern, cryp...Figure 18.5 CLE of GVHD showing nuclear debris representing apoptotic bodies...

10 Chapter 20Figure 20.1 Friability, edema, and erythema of varying degrees eventually as...Figure 20.2 Endoscopic characteristics of herpes esophagitis including mucos...Figure 20.3 Similar characteristics are shown in this figure.Figure 20.4 In epidermolysis bullosa, narrowing of the esophagus is more pro...Figure 20.5 Crohn’s esophageal involvement is usually with aphthoid ulcerati...Figure 20.6 Radiation‐ or chemotherapy‐induced esophagitis can be significan...

11 Chapter 21Figure 21.1 Exudate – whitish coating on the esophageal surface. Exudate rep...Figure 21.2 Circumferential rings along the length of the esophagus. This fi...Figure 21.3 Mucosal edema and linear furrows. These finding are representati...Figure 21.4 Longitudinal rent. This split can occur with the passage of the ...Figure 21.5 Food impaction present in the esophageal lumen. Mucosa is edemat...

12 Chapter 23Figure 23.1 (a) Endoscopy with water immersion showing normal villus pattern...Figure 23.2 (a) Duodenal biopsy specimen with bottom opened and oriented on ...

13 Chapter 25Figure 25.1 Complex esophageal stricture secondary to caustic ingestion.Figure 25.2 Congenital esophageal stenosis with tracheal remnants.Figure 25.3 (a) Fluoroscopic appearance of a balloon waist. The arrow shows ...Figure 25.4 Incisions of the scar performed using a needle knife and a cutti...Figure 25.5 Two‐year‐old boy with complex esophageal stricture due to causti...Figure 25.6 The Dynamic Stent®.Figure 25.7 (a) The Dynamic Stent® in correct position. The two radiopaque b...

14 Chapter 26Figure 26.1 Grade I corrosive esophagitis with diffuse erythema and minimal ...Figure 26.2 Grade IIa corrosive esophagitis: extensive mucosal sloughing.Figure 26.3 Grade IIb of corrosive esophagitis: multiple ulcerations.Figure 26.4 Corrosive gastritis.Figure 26.5 Esophageal stricture after lye ingestion.Figure 26.6 Multiple esophageal strictures two months after caustic ingestio...

15 Chapter 27Figure 27.1 Subtypes of achalasia on high‐resolution manometry: (a) I, (b) I...Figure 27.2 Diagnosis and treatment algorithm based on expert opinion and cu...Figure 27.3 Rigiflex dilator.Figure 27.4 Submucosal injection of methylene blue prior to mucosotomy.Figure 27.5 Lineal mucosal incision.Figure 27.6 Initial stage of tunnel development.Figure 27.7 Creation of a tunnel using an electrical knife and pressure from...Figure 27.8 Completion of the tunnel with exposed circular muscle.

16 Chapter 28Figure 28.1 EndoCinch front‐mounted on the endoscope.Figure 28.2 Suction applied and full‐thickness tissue capture followed by ne...Figure 28.3 Endoscopic gastroplication. This figure shows the pattern of a z...Figure 28.4 View (J manoeuver) of a lax GE junction in a child with major re...Figure 28.5 EndoCinch pediatric series pH efficacy at one year.Figure 28.6 Significant improvement in the total QOLRAD score one and three ...Figure 28.7 The Full‐Thickness Plicator.Figure 28.8 Application of the Full‐Thickness Plicator.Figure 28.9 Retroverted views of stages of application of the Full‐Thickness...Figure 28.10 Distal end of the EsophyX device (a) and SerosaFuse fastener (b...Figure 28.11 Endoscopic images of gastroesophageal valves from two subjects ...Figure 28.12 Operation times comparing endoscopic, laparoscopic. and open fu...Figure 29.13 Hospital stay (days) comparing endoscopic, laparoscopic, and op...Figure 28.14 Total cost comparing endoscopic, laparoscopic, and open fundopl...Figure 28.15 The Stretta system. Use of a balloon to deliver radiofrequency ...Figure 28.16 Injection of liquid polymer into the esophageal mucosa. The Ent...

17 Chapter 30Figure 30.1 Active bleeding F 1b from a duodenal ulcer.Figure 30.2 Adherent clot (F 2b) at the base of a gastric ulcer.Figure 30.3 A flat pigmented spot (F 2c) at the base of a duodenal ulcer.Figure 30.4 Clear base of a duodenal ulcer (F 3).Figure 30.5 Single‐use preloaded rotatable two‐pronged clips: a single clip....Figure 30.6 Over‐the‐scope clip.Figure 30.7 Delivery system.

18 Chapter 31Figure 31.1 Large esophageal varices before and after band ligation.Figure 31.2 (a) EUS varices preinjection. (b) EUS varices with needle.Figure 31.3 Varices being banded.Figure 31.4 Varices with EUS probe.Figure 31.5 Cutting the catheter after glue injection prior to removal to pr...

19 Chapter 32Figure 32.1 Algorithm for the management of OGIB in children. CE, capsule en...

20 Chapter 33Figure 33.1 Finger indentation of the anterior gastric wall.Figure 33.2 Schematic representation of the safe tract technique. In this ca...Figure 33.3 Placement of the blue guidewire through the catheter. A sufficie...Figure 33.4 Internal view of a PEG tube alongside the anterior gastric wall....Figure 33.5 (a) Buried bumper syndrome. The gastrostomy bumper is no longer ...

21 Chapter 34Figure 34.1 Indentation.Figure 34.2 Transillumination.Figure 34.3 Marking the site.Figure 34.4 T‐fastener device.Figure 34.5 Insert the preloaded needle.Figure 34.6 Release the suture thread.Figure 34.7 Bend the locking strip and push the inner hub.Figure 34.8 Pull the T‐bar against the mucosa.Figure 34.9 Slide and close suture lock.Figure 34.10 Gastric view of gastropexy.Figure 34.11 Abdominal view of gastropexy.Figure 34.12 Local anesthesia injection.Figure 34.13 Make the incision.Figure 34.14 Introduce the safety needle.Figure 34.15 Activate safety collar.Figure 34.16 Remove the safety needle while introducing the guidewire.Figure 34.17 Remove the safety needle while introducing the guidewire.Figure 34.18 Dilation of stoma tract.Figure 34.19 Endoscopic view of dilator.Figure 34.20 Remove the dilator.Figure 34.21 Measure the length.Figure 34.22 Continue dilation.Figure 34.23 Keep the endoscopic view.Figure 34.24 Rotate the dilator central part to release the peel‐away sheath...Figure 34.25 Rotate the dilator central part to release the peel‐away sheath...Figure 34.26 Remove the dilator and the guidewire, leaving the peel‐away she...Figure 34.27 Advance the button while peeling the sheath.Figure 34.28 Figure 34.29 Figure 34.30 Endoscopic view of the button revealed as the sheath is peeled ...Figure 34.31 Figure 34.32 Figure 34.33 Peel the sheath down to the skin and remove it.Figure 34.34 Figure 34.35 Figure 34.36 Gastric view of the single‐stage PEG.Figure 34.37 Abdominal view.

22 Chapter 35Figure 35.1 Laparoscopic view of endoscopic light source seen through the sm...Figure 35.2 A Johan instrument is used to occlude the jejunum distal to the ...Figure 35.3 Simultaneous laparoscopic and endoscopic view of trocar inserted...Figure 35.4 Endoscopic view of wire grasped by biopsy forceps.Figure 35.5 PEJ placed – endoscopic (a) and laparoscopic (b) views showing P...

23 Chapter 36Figure 36.1 Endoscopic view of the feeding tube beyond the pylorus.

24 Chapter 37Figure 37.1 Long common channel with choledochal cyst.Figure 37.2 Long common channel with choledochal cyst and choledochocele.Figure 37.3 Two‐year‐old child with rhabdomyosarcoma. Cholangioscopic view w...Figure 37.4 Fluoroscopic view of a 4‐year‐old child with rhabdomyosarcoma du...Figure 37.5 Primary sclerosing cholangitis.Figure 37.6 Fourteen‐year‐old child with traumatic bile leak.Figure 37.7 Seven‐year‐old liver transplant recipient with anastomotic stric...Figure 37.8 Sixteen‐year‐old liver transplant recipient with acute liver fai...Figure 37.9 Fourteen‐year‐old liver transplant recipient with two plastic bi...Figure 37.10 Fourteen‐year‐old liver transplant recipient with fully covered...Figure 37.11 Thirteen‐year‐old child with pancreas divisum and cystic fibros...Figure 37.12 Sixteen‐year‐old child with stent placement cystgastrostomy for...

25 Chapter 38Figure 38.1 Transgastric linear endo‐ultrasound needle puncture of a pancrea...Figure 38.2 The indentation into the gastric wall can be seen easily identif...Figure 38.3 After endo‐ultrasound has identified the cyst and a site which i...Figure 38.4 Grasping forceps are used to manipulate the stents (pig‐tailed [...Figure 38.5 The stents are endoscopically observed in the pseudocyst, and me...Figure 38.6 The endoscope is withdrawn from the pseudocyst.Figure 38.7 The endoscope is withdrawn from the stomach and the gastrocystos...

26 Chapter 39Figure 39.1 Simple balloon dilation of web/diaphragm can be effective alone ...Figure 39.2 Guidewire of endoballoon passing through small apperture in web/...Figure 39.3 Endoballoon has been inflated and gentle traction allows membran...Figure 39.4 Dual‐channel endoscope allows deployment of the endoknife to inc...Figure 39.5 Adequate luminal patency achieved.

27 Chapter 40Figure 40.1 Different types of alternating RF currents and specific tissue r...Figure 40.2 Temperature‐related tissue destruction always induced by RF curr...Figure 40.3 Snare preparation before polypectomy: marking of the so‐called c...Figure 40.4 Squeezing pressure. A 15 mm retraction of the wire into the plas...Figure 40.5 The polyp is within the wire loop.Figure 40.6 The snare is fully closed. Avoid excessive force to prevent ampu...Figure 40.7 Mechanical prophylaxis of bleeding with endo‐clips.Figure 40.8 (a) Tripod forceps. (b) Roth net.Figure 40.9 Hemostasis with argon plasma coagulation.

28 Chapter 41Figure 41.1 (Top left) High‐definition white light images of a proximal asce...Figure 41.2 (Left) Conventional high‐definition white light views of a later...Figure 41.3 ( Left) Endoscopic mucosal resection of the lesion is indicated (...Figure 41.4 (Top left) Conventional high‐definition white light imaging of a...Figure 41.5 ( Left) Conventional white light views of the distal descending c...Figure 41.6 (Left/right) Confocal laser scanning endomicroscopic imaging usi...Figure 41.7 (Left/right) High‐power hematoxylin and eosin staining of the ba...Figure 41.8 ( Left) High‐definition white light imaging of the distal sigmoid...Figure 41.9 ( Left) High‐magnification (100×) chromoscopic colonoscopy (indig...

29 Chapter 42Figure 42.1 Colonoscopic appearance of multiple adenomas >1 cm meriting refe...Figure 42.2 (a) Multiple pedunculated polyps in a 6‐year‐old Caucasian femal...Figure 42.3 (a) Multiple large gastric polyps in the stomach of a 15 year ol...

30 Chapter 43Figure 43.1 (a) Suggested sitting method: TNE insertion pathway below the in...Figure 43.2 Suggested optimal area to pass the transnasal endoscope after in...Figure 43.3 Suggested midline area to pass transnasal endoscope from the pha...

31 Chapter 44Figure 44.1 Intragastric balloon.Figure 44.2 Anchor attached to long polymer impermeable sleeve.Figure 44.3 The delivery device of the sleeve.Figure 44.4 The device introduced over the guidewire.Figure 44.5 The releasing of the device.Figure 44.6 The anchor attached to the duodenal mucosa.Figure 44.7 Pseudopolyps at the site of anchor attachment.

32 Chapter 45Figure 45.1 The full device components.Figure 45.2 Treatment of a point bleeder – before (a) and two days afterward...Figure 45.3 Hemostatic clips.Figure 45.4 Full‐thickness resection.

33 Chapter 46Figure 46.1 Trichobezoar.Figure 46.2 Phytobezoar.Figure 46.3 Trichobezoar endoscopic intervention usually consists of two ste...Figure 46.4 The trichobezoar can be fragmented using various endoscopic devi...