Endoscopic assessment

The following are “Does” from the syllabus

• Endoscopic assessment of Gastro-oesophageal reflux
  • Los Angeles Classification
• Endoscopic assessment of the stricture
• Endoscopic dilatation
• Endoscopic diagnosis and assessment

Stricture and dilatation

• Assessment
  • Location
  • Length
  • Diameter
  • Mucosal characteristics
  • Consistency and pliability
• Dilation
  • Bougie dilators (e.g. Savary-Gilliard)
    • Tapered flexible dilators passed over a guidewire
    • Allow graded dilatation with progressively larger sizes
    • Often used in series over multiple sessions
  • Through-the-scope (TTS) balloons
    • Passed through the working channel of the endoscope
    • Allows visual confirmation of position and response
    • • Available in various diameter ranges (typically 6–20 mm) and lengths (usually 3–5 cm)
    • Some are multi-stage balloons that can be inflated to different sizes in a single device (e.g. 12/13.5/15 mm)
    • Technique
      • Inflate balloon using a manometric inflation device with contrast or saline to target pressure
      • Maintain inflation for 30–60 seconds, or longer if needed (some protocols use 1–2 minutes)
      • Observe tissue blanching to judge adequacy of radial force
      • Deflate and remove the balloon; reassess stricture and mucosal integrity
      • Repeat with larger balloons in staged sessions if necessary