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Endoscopy Master Videos & Lectures
Advanced Endoscopy Master Videos of the following cases:

1  Endoscopic Ultrasound Fine Needle Aspiration (EUS FNAC) of a lymph node in the chest due to lung cancer

2  EUS of a thyroid mass in the chest

3  ERCP plastic stent insertion

4  ERCP peri-ampullary tumor

5  Endoscopic treatment of bleeding from gastric varices in liver cirrhosis

6  Endocopic treatment of bleeding from esophagus varices in liver cirrhosis

7  Colonoscopy and polypectomy

8  EUS FNAC pancreas cancer

9  EUS FNAC of lymph node inthe chest due to sarcoidosis

10 ERCP in a difficult anatomy (Billroth II gastrectomy)

11 Colonoscopy and polypectomy with hemoclip

12 ERCP cannulation and sphincterotomy

13 ERCP precut usig needle knife technique

14 ERCP precut using short nose sphincterotome

15 Stenting of esophagus cancer

16 Endoscopic papillectomy of peri-ampullary villous adenoma

17 ERCP removal of bile duct stones

18 ERCP insertion of metal stent within a metal stent


LECTURES

1 Irritable bowel syndrome
2 Liver Health: prevention & treatment
  


1 EUS FNAC of a lymph node in the chest due to lung cancer
Before EUS was available, the only way to biopsy lymph nodes in the chest was by surgery. Now that EUS is available, some of these lymph nodes lie within reach of the endoscope. The scope is inserted in the esophagus and the lymph nodes are within 5 mm. A small needle < 2 mm diameter is used to obtain cells from the node. EUS FNAC is done on an outpatient basis and takes less than an hour. You can see the fine needle moving in and out of the node, sucking out cancer cells for analysis. Fine and steady movement is needed because of the node lies just in front of the heart, the left atrium.  


2 EUS of a thyroid mass in the chest



3 ERCP plastic stent insertion
ERCP is used to insert a plastic tube (stent) into the bile duct. This is used to un-block a cancer in the pancreas. By relieving the blocked bile duct, the patient's jaundice (yellow discoloration) improves and he feels better. You can see the blue plastic stent being inserted through the bile duct opening (papilla) and the gush of bile afterwards.



4 ERCP peri-ampullary tumor
ERCP shows a swollen opening to the bile duct (papilla). This was due to a cancer growing within the opening. The papilla is cut to expose the cancer tissue and obtain sufficient biopsy material for diagnosis and confirmation.


5 Endoscopic treatment of bleeding from gastric varices in liver cirrhosis
Liver cirrhosis causes pressure build-up in the liver that is transmitted to the veins in the esophagus and stomach. This causes swelling of the veins in these areas. These veins (varices) can bleed and are a medical emergency. You can see how such a case is treated by endoscopy. The varices are ligated with rubber bands and effectively stops the bleeding.


6 Endocopic treatment of bleeding from esophagus varices in liver cirrhosis
Liver cirrhosis causes pressure build-up in the liver that is transmitted to the veins in the esophagus and stomach. This causes swelling of the veins in these areas. These veins (varices) can bleed and are a medical emergency. You can see how such a case is treated by endoscopy. The varices are injected with a special glue and effectively stops the bleeding.


7 Colonoscopy and polypectomy
Colonoscopy screening is advocated by the Ministry of Health for persons 50 years or older when they are healthy and do not have symptoms. This is because colon cancer is the commonest cancer in Singapore and colonoscopy screening can detect cancer early and save lives. Polyps that are found incidentally can be removed and they are prevented from turning into cancer. High risk persons include those with a family history of colon cancer, colon polyps, or personal history of inflammatory bowel disease. You can see the colon polyp being removed by the snare polypectomy method. A sterile electric wire is used to cut the polyp stalk, leaving behind a small wound that will heal in two weeks.


8 EUS FNAC of pancreas cancer
EUS FNAC is used to obtain cells from a pancreas cancer. The information is needed to confirm cancer before starting chemotherapy. You can see the round cancer and the needle moving in and out, sucking cells for analysis. This usually takes less than one hour and the patient can go home after that.


9 EUS FNAC of a lymph node in the chest due to sarcoidosis
EUS FNAC is used to diagnose the cause of this patient's enlarged lymph nodes in the chest. You can see the needle moving in and out of the node, sucking cells for anaylsis. The final diagnosis was sarcoidosis, a chronic inflammation of the nodes, that was responsive to steroids.
Fine and steady movement is needed because of the node lies just in front of the heart, the left atrium.


10 ERCP in a difficult anatomy (Billroth II gastrectomy)



11 Colonoscopy and polypectomy with hemoclip
Colonoscopy screening is advocated by the Ministry of Health for persons 50 years or older when they are healthy and do not have symptoms. This is because colon cancer is the commonest cancer in Singapore and colonoscopy screening can detect cancer early and save lives. Polyps that are found incidentally can be removed and they are prevented from turning into cancer. High risk persons include those with a family history of colon cancer, colon polyps, or personal history of inflammatory bowel disease. You can see the colon polyp being removed by the snare polypectomy method. A sterile electric wire is used to cut the polyp stalk, leaving behind a small wound that will heal in two weeks. A metal clip was used in this case because of the large size and to prevent bleeding.


12 ERCP cannulation and sphincterotomy
ERCP is used to diagnose the cause of bile duct blockage. You can see the opening in the bile duct (papilla) being cut open with a small wire knife (sphincterotome). This will allow stones to be removed if they are the cause of blockage.


13 ERCP precut using needle knife technique
ERCP can be difficult in some cases due to variations in anatomy. In these situations, a method called pre-cut is used to cut the bile duct opening. This is done only by experienced doctors.


14 ERCP precut using short nose sphincterotome
ERCP can be difficult in some cases due to variations in anatomy. In these situations, a method called pre-cut is used to cut the bile duct opening. This is done only by experienced doctors.


15 Stenting of esophagus cancer
Esophagus cancer causes blockage of the swallowing passage leading to painful swallowing and slow starvation. Stenting is a method to place a metal tube to open up the blockage. This allows the patient to swallow liquids and a finely miced diet, thereby improving his quality of life.




16 Endoscopic papillectomy (I) of peri-ampullary villous adenoma
ERCP shows an enlarged papilla at the opening of the bile duct. This is a pre-cancerous polyp and needs to be removed. You can see the polyp being cut up in several pieces. This procedure is done only by experienced doctors.


17 Endoscopic papillectomy (II)
ERCP shows an enlarged papilla at the opening of the bile duct. This is a pre-cancerous polyp and needs to be removed. You can see the polyp being cut up in several pieces. This procedure is done only by experienced doctors.


18 ERCP removal of bile duct stones
ERCP shows an enlarged papilla due to stone causing obstruction of the bile duct. The opening is cut, followed by a gush of infected bile. The stone is then removed.



19 ERCP insertion of metal stent within a metal stent
ERCP shows an advanced pancreas cancer with very rapid ingrowth and overgrowth into a metal stent inserted only one month earlier. This was an almost impossible ERCP to perform in a severely ill patient.


Lectures




 
 
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Dr Yap Chin Kong

 

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