Cotton and Williams' Practical Gastrointestinal Endoscopy

Catharine M. Walsh, MD, MEd, PhD, FRCPC is an Associate Professor of Paediatrics at The Hospital for Sick Children, University of Toronto, Toronto, Canada.

Ahmir Ahmad, MBBS, BSc, MRCP, PhD is a Consultant Gastroenterologist at St. Mark’s Hospital, London, UK.

Brian P. Saunders, MD, FRCP, FRCS is a Consultant Gastroenterologist at St. Mark’s Hospital and Professor of Endoscopy at Imperial College, London, UK.

Jonathan Cohen, MD, FASGE, FACG is a Clinical Professor of Medicine at the NYU Grossman School of Medicine, New York, USA.

Peter B. Cotton, MD, FRCP, FRCS is a Professor of Medicine at the Medical University of South Carolina, Charleston, USA.

Christopher B. Williams, BM, FRCP, FRCS was a Consultant Physician in Gastrointestinal Endoscopy at St. Mark’s Hospital, London, UK.

List of Video Clips viii

Preface to the Eighth Edition x

Preface to the First Edition xi

Acknowledgments xii

About the Companion Website xiii

1 Welcome to Endoscopy 1

Resources and links 4

2 The Endoscopy Unit Staff and Management 6

Endoscopy units 6

Staff 9

Management behavior and teamwork 10

Documentation and quality improvement 10

Educational resources 11

Further reading 11

3 Endoscopic Equipment 13

Endoscopes 13

Endoscopic accessories 18

Ancillary equipment 19

Electrosurgical units 20

Lasers and argon plasma coagulation 20

Equipment maintenance 21

Infection control 22

Cleaning and disinfection 22

Further reading 26

4 Patient Care Risks and Safety 27

Patient assessment 27

Patient education and consent 32

Physical preparation 37

Sedation/anesthesia 37

Recovery and discharge 40

Managing adverse events 40

Further reading 41

5 Upper Endoscopy: The Fundamentals 43

Patient position 43

Endoscopist position 44

Endoscope Handling 44

Passing the endoscope 45

Routine diagnostic survey 48

Stomach 50

Problems during endoscopy 56

Recognition of lesions 57

Specimen collection 62

Diagnostic endoscopy under special circumstances 65

Further reading 67

6 Therapeutic Upper Endoscopy 69

Benign esophageal strictures 69

Achalasia 73

Esophageal cancer palliation 74

Gastric and duodenal stenoses 77

Gastric and duodenal polyps and tumors 78

Foreign bodies 78

Acute bleeding 82

Enteral nutrition 90

Further reading 94

7 Colonoscopy and Flexible Sigmoidoscopy 97

History 97

Indications and limitations and alternatives 97

Informed consent 101

Contraindications and infective hazards 102

Patient preparation 103

Medication 110

Equipment—present and future 114

Anatomy 119

Insertion 125

Handling “single-handed” “two-handed” or two-person? 127

Sigmoid colon—accurate steering 131

Endoscopic anatomy of the sigmoid and descending colon 134

Sigmoid colon—the bends 137

Sigmoid colon—the loops 137

Diverticular disease 145

Descending colon 147

Splenic flexure 148

Transverse colon 152

Hepatic flexure 156

Ascending colon and ileo-cecal region 158

Overtubes and balloon colonoscopy 165

Examination of the colon 165

Stomas 174

Pediatric ileocolonoscopy 174

Per-operative colonoscopy 175

Further reading 176

8 Therapeutic Colonoscopy 179

Equipment 179

Principles of polyp electrosurgery 182

Approach to polypectomy 185

Selection of polypectomy technique 187

Polypectomy: Diminutive and small polyps 187

Polypectomy: Large polyps 191

Polypectomy: Problem polyps 198

Recovery of polypectomy specimens 200

Risks of polypectomy 202

Other therapeutic procedures 205

Further reading 208

9 Advanced Endoscopic Procedures 211

Small bowel endoscopy 211

Endoscopic retrograde cholangiopancreatography (ERCP) 212

Endoscopic ultrasound (EUS) 212

Bariatric endoscopy 212

Anti-reflux procedures 213

Third space procedures and NOTES 213

Epilogue: The Future? Comments from the Senior Authors 214

Index 216