GI Endoscopy · 1 min read
Caps in GI Endoscopy
Experienced teaching points
Clinical Pearls
- When a duodenoscope is unavailable, attaching a distal transparent cap to a forward-viewing upper endoscope is the best alternative for detailed inspection of the major papilla.
- A distal cap is especially useful in patients with familial polyposis (FAP) syndromes, allowing the endoscopist to maneuver duodenal folds and visualize papillae that are otherwise hidden from a standard forward-viewing scope.
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Question
What is the best way to inspect the papilla of Vater in the abscence or lack of availability of a duodenoscope (side-viewing scope, ERCP scope)?
Answer
Today we present a useful tip for inspection of the papilla of Vater using distal transparent cap.
A close and detailed inspection of the major papilla may be needed in a variety of clinical situations, for example, during upper endoscopy of a patient with a familial polyposis syndrome (FAP) or duodenal adenomas Although some papillae may be seen well with forward-viewing instruments, many are partially or fully hidden behind duodenal folds and, therefore, are outside the field of view of a standard upper endoscope. Using a distal transparent cap allows visualization and inspection of virtually every major papilla without having to resort to the use of a second endoscope—that is, a duodenoscope. See attached figure.
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