tions, according to Dr. Kaul. For example, he says
the small-caliber endoscopes can, in many cases, be
placed directly into the bile duct through the duode-
nal opening for evaluation of the biliary tree. This
direct peroral cholangioscopy technique is more
effective than indirect peroral cholangioscopy,
notes Dr. Kaul.
Invaluable
instruments
The functionality of ultrathin
endoscopes has also improved in
recent years. Older models were
outfitted with a single dial that
physicians used to direct the
scope's tip in two-way deflection.
The latest models have dual-dial,
four-way deflection — similar to
the controls found on standard
colonoscopes and upper gastro-
scopes — that facilitate move-
ments in tight spaces.
Dr. Adler says all major endo-
scope manufacturers make ultra-
thin upper endoscopes that are
highly functional, and notes ultra-
thin models should come with all
the features of standard flexible
scopes. "Ultrathin scopes must be
comparable to a standard scope
in terms of maneuverability,
image quality and image capture,"
says Dr. Adler. "A scope that
lacks any of those features would
be disadvantageous to use."
The devices are delicate and
expensive instruments, and sus-
ceptible to the same level and
degree of breakdown as all flexi-
ble endoscopes, points out Dr.
Kaul. "They require constant care
and high-level disinfection with
the same reprocessing guidelines
and processes as standard
scopes," he says.
Ultimately, Dr. Kaul believes
ultrathin endoscopes are important instruments
to have in any endoscopy suite. "They help physi-
cians perform many different procedures at the
very basic level and lead to successful proce-
dures that otherwise would have ended in fail-
ure," he says.
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