Special use of ultra-fine endoscopic

high-resolution, small-calibre electron endoscopenoty not only provides high-definition images, but also improves safety and patient tolerance through nasal path insertionThis technology has broad clinical application prospectsIn the process of applying ultra-fine electronic endoscopes, we have tried several special diagnostic and treatment operations with the help of the characteristics of the type endoscope outer diameter fine, can be operated through the nasal cavityThe endoscopy of the esophageal metal stent placement under the nose endoscopy monitoredesophageal metal stent placement is an endoscopy technique for clinical treatment of good malignant esophageal narrownessFor esophageal cancer patients who have lost the opportunity for curly surgery due to local immersion, metastasis, or severe comorbidities, the resumption of feeding function through the placement of esophageal self-puffing metal stents has become a common palliative treatmentThe traditional method is to use X-ray positioning, inject the contrast agent under the mucous membrane through the endoscope or mark the narrow near and far end boundaries with titanium metal, select the appropriate bracket and pusher according to the narrow length, and insert it into the guide wireRelease the bracket at 2 cm beyond the narrow section under X-rayThe stent placement process of the lower esophageal metal stent placement under the nose endoscopy monitoring is not fundamentally different from the traditional method, except that in the process of stent release, the former uses the ultra-fine endoscope inserted by the nasal cavity to monitor, while giving full play to the characteristics of the ultra-fine endoscope easy to pass through the narrow section of the digestive tract, making the placement of the metal stent simple and convenient, and the operation does not need to be marked in advance, avoiding the endoscopy doctor and the patient's X-ray exposureThe procedure is first inserted into the ultra-fine endoscope through the portOur ultra-fine electronic endoscope has an outer diameter of 5.6 mm, making it easy to pass through narrow esophagus, and in most cases does not require pre-expansion, allowing a small number of patients to slightly expand depending on the size of the stent pusherAccurately measure the length of the narrow section under the endoscope, insert a guide wire through the endoscopic biopsy clamp channel to reach the far end of the stomach, slowly retreat the mirror, and insert and leave the guide wireSelect the appropriate bracket and pusher to make an external tag at the top edge of the bracket outside the pusherIf a metal bracket with a transparent pusher is used, most of the upper edges of the bracket are clearly visible inthetreThe guide wire slowly inserts the bracket pusher into and through the narrow section, inserts the ultra-fine endoscope through the nasal cavity into the esophagus, stays at the narrow near end, looks directly at the endofer, moves the marker of the upper edge of the pusher bracket to the narrow upper edge 2 cm, then moves the inner sleeve fixed according to the usual method, slowly pulls back the coat tube, and begins to release the bracketWhen releasing a transparent pusher with a visual intagtruded, the sliding and release of the bracket in the pusher can be observed under the endoscopeOnce the bracket is released and the pusher is completely exited, it is able to push through the metal bracket through the nose ultra-fine endoscope and observe the position of the bracket and the far end of the bracket The nasal endoscopy-assisted nasal intestinal tube placement intraintestinal nutrition support plays a key role in improving the prognosis of critically ill patients The ultra-fine nasal intestinal tube inlet (ENET) under the nasal endoscopy significantly alleviates the patient's pain by avoiding operations such as endoscopy traction, push, or mouth-nose conversion The operation process (Figure 1-3) first through the nasal cavity inserted ultra-fine endoscope, and as far as possible inserted, to reach the third or fourth segment of the duodenum, through the endoscopic biopsy clamp channel inserted a guide wire (such as 0.035 inches yellow zebra guide wire), so that it enters and extends to the far end of the duodenum, it is best to make the front of the soft ness as much as possible into the empty intestine, until encountering minor resistance Continue to insert the guide wire while slowly exiting the endoscope, sucking out the gas in the stomach during the withdrawal process, leaving the guide wire in place until the endoscopy completely exits the nostrils Directly insert the nasal intestinal feeding tube (preferably pre-lubricated the inner wall) through the nostrils of the retained guide wire, insert along the guide wire, and insert the guide edge at the end of the feeding tube It is worth noting that this thread exchange process is more refined, so it should be ensured that the feeding tube downward insertion of the nasal cavity speed is exactly the same as the guide wire exit from the end of the feeding tube, until the guide wire completely exit, at this time the feeding tube head end has reached the far end of the duodenum or the upper section of the empty intestine The ultrafine endoscopy can be inserted again through the mouth or the other side of the nostrils, or verified by x-ray injection sputions (Yang Yonghui)