Therapeutic endoscopes such as on the image on the right may have 2 accessory channels. This is covered by the biopsy cap which creates an air tight seal necessary for the suction channel to operate. Accessory/Biopsy channel opening: This allows passage of biopsy forceps and other instruments to undertake therapy.Image 7: Accessory/ Biopsy channel and biopsy cap. It is recommended that just the index finger is used alternating between the two valves to avoid this scenario. The result is a distended bowel with tight angulations and a very uncomfortable patient. This results inadvertently in the opening of the blue air/ water valve being covered resulting in uncontrolled insufflations. Top tip #1 Trainees have a tendency to use the index finger and the ring finger each to control both the buttons simultaneously. A biopsy cap needs to be in situ covering the accessory channel for the endoscope to generate the suction needed. This is connected to the accessory channel. Red suction valve: When depressed this aspirates air or fluid through the distal tip.Full depression flushes water to clear the lens. Covering its opening or partial depression feeds air from the distal tip. Blue Air/Water valve: This is used to control the insufflations of air or flush water to clear the lens.Left/right deflection lock: It Locks the right and left deflection wheel.In endoscopic view small wheel down results in the endoscope angulating left and vice versa. Left/right deflection wheel (Small wheel): This moves the tip of an endoscope left or right.Image 5: View of the deflection wheels and locks (Front view) Image 4: View of the deflection wheels and locks (side view) This is usually in the setting of endoscopic therapy/ targeted biopsy. This allows the endoscopist to lock his wheel in a particular position. To lock your wheel one needs to turn in the opposite direction of the arrow. Up/down deflection lock: It is the knob with F written on it.To further confuse you in actual 3 Dimension the endoscope is actually bending downwards but due to the way the optics and the visual image are organized it seems to be in the opposite direction. In the endoscopic view big wheel down results in the endoscope angulating upwards and vice versa. Up/down deflection wheels (Big wheel): This wheel moves the tip of an endoscope up or down.Water jet nozzle- water introduced with a syringe through the forward water jet connector comes to this port and gives a more powerful blast of water.Objective lens allows visualisation of the mucosa.First & second light guide which act as a light source.This is at 5 o’ clock position (endoscopic view) in a colonoscope and 7 o’ clock position in a gastroscope. Distal tip of an endoscope consists of :.Image 3: Components at Distal tip Courtesy Pentax Image 2: Distal tip of an endoscope courtesy Pentax Bending section: This allows manoeuvrability of the tip with movements up, down, left and right in response to turning the deflection wheels.Recent innovation with the now commonly available variable stiffness and the new overtube ShapeLock Endoscopic Guide (ShapeLock, USGI Medical, San Clemente, CA) has allowed endoscopist more control in preventing looping and reducing discomfort to the patient. It is susceptible to looping particularly during colonoscopy. Flexible shaft: This is the part of the endoscope that transmits the push, pull and torque forces to the tip.Image 1: The different parts of an endoscope: Courtesy Olympus Establishment of Gastrointestinal Endoscopy Areas.Iron Replacement (parenteral dosing) for Iron Deficiency.
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