Since the 1960s, the instrumentation and technique of flexible endoscopic examination of the gastrointestinal tract have established it as the dominant modality for the diagnosis of gastrointestinal disease. The therapeutic potential of flexible endoscopy is rapidly expanding and transforming the endoscopist from a casual observer to an interventionalist who is able to respond to a variety of problems that could previously be addressed only by surgical intervention.
The first generation of flexible endoscopes used fiberoptic bundles to transmit light into the intestinal lumen and
Figure 3-1 An upper gastrointestinal series demonstrating an "upside down" stomach, a type of paraesophageal hernia. This study is useful in planning surgery.
Figure 3-2 A view of the vocal cords may be routinely obtained at the time of upper endoscopy. The esophageal opening is just posterior.
Figure 3-3 The ampulla of Vater, in the second portion of the duodenum, may be associated with periampullary diverticula.
Figure 3-4 A retroflex view of the cardia and fundus permits inspection for lesions that are difficult to see on Introduction of the instrument. Here, a hiatus hernia Is noted.
Figure 3-5 Severe hemorrhagic esophagitis in a child with severe gastroesophageal reflux disease.
Figure 3-6 Schatzke's ring, a fixed mucosal ring above a hiatus hernia. These are easily dilated.
Figure 3-11 An endoscopic ultrasound image demonstrating esophageal carcinoma (LSN) and an adjacent metastatic lymph node (LN).
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Gastroesophageal reflux disease is the medical term for what we know as acid reflux. Acid reflux occurs when the stomach releases its liquid back into the esophagus, causing inflammation and damage to the esophageal lining. The regurgitated acid most often consists of a few compoundsbr acid, bile, and pepsin.