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The Secret of Gritflowness - October 2020 - Subscribe to Outpatient Surgery Magazine

Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.

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selves home or to work as soon as it ends." It's a great concept, at least in theory. Douglas Adler, MD, FACG, AGAF, FASGE, says more practical applications of ultrathin scopes involve maneuvering around complex strictures and post-surgical anatomy in upper GI tracts or use in pediatric patients who can't toler- ate an adult scope. Dr. Adler, a professor of medicine at the University of Utah School of Medicine and Huntsman Cancer Center in Salt Lake City, believes the primary benefit of ultrathin scopes is that they can be used in office-based settings. "But very few gastroenterologists perform office- based endoscopy procedures because they're used to performing a complete upper examination, which includes the esophagus, stomach and the beginning segment of the small bowel," he says. Most in-office sedationless exams include the esophagus and perhaps the beginning portion of the stomach due to patient tolerance, accord- ing to Dr. Adler. "Culturally, physicians feel like esophageal screening procedures are incomplete exams," he says. "What if they miss a stom- ach ulcer they would have seen with a standard endoscope?" Plenty of applications Dr. Kaul says ultrathin endoscopes are ideally suited for performing exams in patients with narrowing at the upper esophageal sphincter and the gastroesophageal junction, and in the pylorus and duodenum. "That's where these devices are most helpful," he explains. "They let physicians complete examinations that would not be possible using standard endoscopes." Physicians who run into difficulty moving a colonoscope through narrow areas of the colon often opt for a standard gastroscope, which has a smaller diameter and the rigidity needed to maneuver through the colon. Dr. Kaul says ultrathin endoscopes, which are too narrow and too flexible, are not typically used during colonoscopy exams. Ultrathin scopes can prove useful in facilitating stenting for col- orectal malignancies in the lower GI tract, however. "Physicians who need to access a tumor beyond a narrowing of the tract during a colonoscopy, but are unsure of where to place the guidewire, can remove the colonoscope and insert an ultrathin gastroscope, enter the O C T O B E R 2 0 2 0 • O U T P A T I E N T S U R G E R Y . N E T • 4 1 Enhanced imaging helps physicians identify lesions, better characterize the mucosal lining and facilitate mapping of abnormal anatomy. — Vivek Kaul, MD, FACG, FASGE, AGAF

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