OESOPHAGOGASTRO –

DUODENOSCOPY (OGDS)
ANATOMICAL IDENTIFICATION

HANS ALEXANDER MAHENDRAN MD, MS

ENDOSCOPIST
 LESSER CURVATURE

POSTERIOR WALL
ANTERIOR WALL

GREATER CURVATURE
 LESSER CURVATURE

POSTERIOR WALL
ANTERIOR WALL

FUNDUS GREATER CURVATURE

 LESSER CURVATURE
ANTRUM

POSTERIOR WALL
ANTERIOR WALL

FUNDUS GREATER CURVATURE

 LESSER CURVATURE

POSTERIOR WALL
ANTERIOR WALL

GREATER CURVATURE
 ANTERIOR WALL

PERITONEAL
PANCREAS

POSTERIOR WALL
 ANTERIOR WALL

PERITONEAL
PANCREAS

POSTERIOR WALL
Yao, K. The endoscopic diagnosis of
early gastric cancer. Ann.
Gastroenterol. 26, 11–22 (2013).
BENIGN PYLORIC STENOSIS
COMMON STRATEGIES ARE
DILATATION
STENTING?
BENIGN PYLORIC STENOSIS
COMMON STRATEGIES ARE
DILATATION
STENTING?
BENIGN PYLORIC STENOSIS
COMMON STRATEGIES ARE
DILATATION
STENTING?
BENIGN PYLORIC STENOSIS
COMMON STRATEGIES ARE
DILATATION
STENTING?
 MAJORITY OF RECALCITRANT
ULCERS THAT CAUSE DEFORMITY
THAT
RESULTS IN GASTRIC OUTLET
OBSTRUCTION
 MAJORITY OF RECALCITRANT
ULCERS THAT CAUSE DEFORMITY
THAT
RESULTS IN GASTRIC OUTLET
OBSTRUCTION

ARE EITHER OLD/SEALED

PERFORATIONS
 MAJORITY OF RECALCITRANT
ULCERS THAT CAUSE DEFORMITY
THAT
RESULTS IN GASTRIC OUTLET
OBSTRUCTION

ARE EITHER OLD/SEALED

PERFORATIONS
OR
BEST APPROACHED AS MALIGNANT
 NASOJEJUNAL SILICONE TUBE
AN ALTERNATIVE FEEDING CONDUIT
 NASOJEJUNAL SILICONE TUBE
AN ALTERNATIVE FEEDING CONDUIT
FOR
DECOMPRESSION
 NASOJEJUNAL SILICONE TUBE
AN ALTERNATIVE FEEDING CONDUIT
FOR
DECOMPRESSION
NUTRITIONAL SUPPLEMENTATION
UNTIL
DEFINITIVE SURGERY
STENTING
COST
COMPLICATIONS
CAN MAKE EVENTUAL SURGERY A
BIT MORE TRICKY
STENTING
COST
COMPLICATIONS
CAN MAKE EVENTUAL SURGERY A
BIT MORE TRICKY
STENTING
COST
COMPLICATIONS
CAN MAKE EVENTUAL SURGERY A
BIT MORE TRICKY
STENTING
COST
COMPLICATIONS
CAN MAKE EVENTUAL SURGERY A
BIT MORE TRICKY
WE USE AN
OLYMPUS
GIF-H190
TIP 5.9MM
CHANNEL 2MM
LENGTH
1030MM
Dilatation
anatomy is important
recurrent dilatations may be reqired
 NASOJEJUNAL SILICONE TUBE
AN ALTERNATIVE FEEDING CONDUIT
FOR
DECOMPRESSION
 NASOJEJUNAL SILICONE TUBE
AN ALTERNATIVE FEEDING CONDUIT
FOR
DECOMPRESSION
BENIGN GASTRIC OUTLET
OBSTRUCTION
MALIGNANT GOO
 NASOJEJUNAL SILICONE TUBE
AN ALTERNATIVE FEEDING CONDUIT
FOR
DECOMPRESSION
BENIGN GASTRIC OUTLET
OBSTRUCTION
MALIGNANT GOO
DISTAL OESOPHAGEAL OBSTRUCTION
 NASOJEJUNAL SILICONE TUBE
AN ALTERNATIVE FEEDING CONDUIT
FOR
DECOMPRESSION
BENIGN GASTRIC OUTLET
OBSTRUCTION
MALIGNANT GOO
DISTAL OESOPHAGEAL OBSTRUCTION
 NASOJEJUNAL SILICONE TUBE
AN ALTERNATIVE FEEDING CONDUIT
FOR
DECOMPRESSION
BENIGN GASTRIC OUTLET
OBSTRUCTION
MALIGNANT GOO
DISTAL OESOPHAGEAL OBSTRUCTION
 NASOJEJUNAL SILICONE TUBE
AN ALTERNATIVE FEEDING CONDUIT
FOR
DECOMPRESSION
BENIGN GASTRIC OUTLET
OBSTRUCTION
MALIGNANT GOO
DISTAL OESOPHAGEAL OBSTRUCTION
 NASOJEJUNAL SILICONE TUBE
AN ALTERNATIVE FEEDING CONDUIT
FOR
DECOMPRESSION
BENIGN GASTRIC OUTLET
OBSTRUCTION
MALIGNANT GOO
DISTAL OESOPHAGEAL OBSTRUCTION
 NASOJEJUNAL SILICONE TUBE
AN ALTERNATIVE FEEDING CONDUIT
FOR
DECOMPRESSION
BENIGN GASTRIC OUTLET
OBSTRUCTION
MALIGNANT GOO
DISTAL OESOPHAGEAL OBSTRUCTION
About 200 insertions
Tubes are usually a temporary measure as a bridge to definitive
surgery
Rarely for palliation [patient’s choice]

The mean insertion time was 18.3 minutes [SD +4.33] and the mean
duration of use of the tube was 44.4 days [SD +27.42].

These tubes were usually used prior to surgery and maintained during
the post-operative phase until normal feeding could be
resumed.
Disadvantage
Need the neonate scope for tight strictures/stenosed openings
Possible to sometimes dilate to admit normal endoscope but
the added problem of bringing the soft silicone tube down
Disadvantage
The narrow lumens do get obstructed easily if not well cared for
Training is essential
Nurses and paramedics need to be reminded as the patient
will seek them for advice – which may be erronous
Useful alternative and are beneficial
in the management of obstructions
of the upper GI tract
Thank you