Chapter
I Introduction to Endoscopy
1 Education and Training in Endoscopy
1.2.1 Clinical Training to Competency in Esophagogastroduodenoscopy and Colonoscopy: Studies, Guidelines, and Assessment
1.2.2 Training in Endoscopic Retrograde Cholangiopancreatography
1.2.3 Complementary E-learning and Video Courses
1.3 Incorporation of Simulators in Training
1.4 Endoscopy Simulators and Training Models
1.4.1 Plastic Phantoms and Other Static Models
1.4.2. Computer Simulators
1.4.3 Training Courses with Live Animals
1.4.4 Ex Vivo Porcine Tissue Models (EASIE, Erlanger Endo-Trainer, EASIE-R)
1.4.6 Incorporating Simulator Training into Educational Programs and Maintaining Skills in Complex Procedures
2 The Value of Clinical Research
2.3 Designing Clinical Trials
2.3.3 Clinical Trial Design
2.3.5 Conducting Clinical Trials
2.3.6 Presentation and National Meetings
2.4.1 Conflict of Interest
2.4.2 Registration of Clinical Trials and Underreporting of Negative Trials
2.4.3 Falsification of Data
2.5 Manuscript Submission and Review Process
2.5.1 Expanding the Reach
2.5.2 The Future of Scientific Publications
II The Patient and Endoscopy
3 Informed Consent for Gastrointestinal Endoscopy
3.2 What Is “Informed Consent”?
3.3 Clinician and Patient Relationship
3.4 What Information Is Required?
3.5 How Should the Information Be Provided?
3.6 Where and When Should the Consent Be Taken?
3.7 Withdrawal of Consent
3.8 Exceptions to the Requirement of Consent
4 Patient Preparation and Sedation for Endoscopy
4.2 Presedation Assessment
4.3 Monitoring during Endoscopic Sedation
4.3.2 Hemodynamic Monitoring
4.4.5 Who Should Perform Endoscopic Sedation?
4.5.1 Monitoring during Recovery
5 Design of the Endoscopy Suite
5.2 General Questions and Considerations
5.3 Guidelines for Planning an Endoscopy Suite
5.4 Pathways for Patients, Staff, and Material
5.8 The Endoscopic Examination Room
5.8.3 Monitor Systems and Anesthesia
5.8.4 Video Integration and PC-Based Documentation
5.8.5 Endoscopes and Endoscopic Equipment
5.9 Endoscopic Ultrasound and Laser Treatment Room, Radiography Room
5.10 Preparation and Recovery Room
5.11 Cleaning and Disinfection Area
6 Cleaning and Disinfection in Endoscopy
6.2 Principles of Disinfection
6.2.2 Application to Gastrointestinal Endoscopes
6.2.3 Liquid Chemical Germicides and Automated Endoscope Reprocessors
6.3 Transmission of Infection by Gastrointestinal Endoscopy
6.3.1 Transmission by Endoscopes with Elevators
6.3.2 Failure or Breach in Reprocessing
6.4 Design and Oversight of Reprocessing Facilities
7 Electrosurgical Principles for Endoscopy
7.2 Electrosurgical Principles
7.2.1 Electrical and Tissue Variables
7.2.2 Monopolar versus Bipolar Circuit
7.3 Electrosurgical Units and Waveforms
7.4 Practical Applications
7.5 Electrosurgical Hazards and Safety
7.5.1 Unintended Burn Injury
7.5.2 Implanted Electromagnetic Devices
8 Antibiotic Prophylaxis in Endoscopy
8.2 Bacteremia Related to Endoscopic Procedures
8.2.1 Procedures Associated with Low Risk of Bacteremia
8.2.2 Procedures Associated with High Risk of Bacteremia
8.3 Antibiotic Prophylaxis for the Prevention of Infective Endocarditis
8.3.1 Antibiotic Prophylaxis for the Prevention of Procedural-Related Infections (Other Than IE)
8.5 Percutaneous Endoscopic Gastrostomy/Jejunostomy
8.6 Cirrhosis with GI Bleeding
8.7 Synthetic Vascular Grafts and Other Nonvalvular Cardiovascular Devices
8.8 Orthopaedic Prostheses
8.9 Patients Receiving Peritoneal Dialysis
9 Quality Assurance in Endoscopy
9.1 The Importance of Quality
9.3 Practicalities of Measurement
9.3.1 Clinical Importance
9.3.4 Governance Infrastructure
10 Endoscopic Complications
10.2 General Considerations
10.2.1 Cardiopulmonary and Sedation-Related Events
10.3 Upper Gastrointestinal Endoscopy
10.3.1 Diagnostic Upper Gastrointestinal Endoscopy
10.3.2 Therapeutic Upper Gastrointestinal Endoscopy
10.3.3 Management of Upper Gastrointestinal Perforation
10.3.4 Management of Upper GI Bleeding
10.4 Small Bowel Endoscopy
10.5.2 Management of Colonic Perforation
10.5.4 Unusual Complications
10.6.4 Post-ERCP Pancreatitis
10.7.1 EUS-Guided Celiac Block/Neurolysis
10.7.2 EUS-Guided Drainage of Pancreatic Fluid Collections
10.7.3 Peroral Endoscopic Myotomy
11 Anticoagulation and Endoscopy
11.2.1 Antiplatelet Agents
11.2.2 Anticoagulants Agents
III General Diagnostic and Therapeutic Procedures and Techniques
12 Upper Gastrointestinal Endoscopy
12.1 History of Upper Gastrointestinal Endoscopy
12.2 General Diagnostic Techniques
12.3 Preparation of the Patient
12.5 Use of Antifoaming Agents and Antispasmotics
12.6 Procedural Steps for Upper Gastrointestinal Endoscopy
12.6.1 Insertion and Observation
12.6.3 Esophagogastric Junction
12.6.4 Stomach and Duodenum
12.6.5 Transnasal Upper Endoscopy
12.7 Common Pathologies for Upper Gastrointestinal Endoscopy
12.7.1 I: Upper Gastrointestinal Cancers
12.7.2 II: Upper Gastrointestinal Hemorrhage
12.7.3 III: GERD and Barrett’s Esophagus
12.10 Barrett’s Esophagus–Related Dysplasia
12.11 Complications of Upper Gastrointestinal Endoscopy
13 Enteroscopy Techniques
13.2 Overview of Enteroscopy Procedures
13.2.1 Anatomical Characteristics of the Small Intestine
13.2.2 Classification and Principles of Device-Assisted Enteroscopy
13.2.3 Balloon-Assisted Enteroscopy (Double-Balloon Endoscopy/Single-Balloon Endoscopy)
13.3 General Diagnostic Techniques
13.4 General Therapeutic Techniques
13.4.3 Polypectomy/Endoscopic Mucosal Resection
13.4.4 Retrieval of Foreign Bodies
13.5 Accessory Devices and Techniques
13.6 Indications for the Use of Device-Assisted Enteroscopy
13.6.1 Indications for Diagnostic Use
13.6.2 Indications for Follow-Up of Small Intestinal Lesions
13.6.3 Therapeutic Indications for Device-Assisted Enteroscopy
13.6.4 Miscellaneous Indications for Device-Assisted Enteroscopy
13.7 Procedure-Specific Quality Measures
13.8 Procedure-Specific Training Requirements
13.8.1 Minimizing Air Insufflation for Deep Intubation
13.8.2 Necessity of X-Ray Fluoroscopy during Device-Assisted Enteroscopy
13.9 Minimizing Procedure-Specific Complications
13.9.1 Complications of Balloon-Assisted Endoscopy
13.9.2 Complications of Spiral Endoscopy
14 Wireless Video Capsule Endoscopy
14.3 Setting and Preparation for Video Capsule Endoscopy
14.6 Contraindications to VCE
14.7 Risk of VCE Retention
15 Colonoscopy: Preparation, Instrumentation, and Technique
15.2.1 Indications and Contraindications
15.2.2 Patient Preparation
15.3 Basic Instrumentation
16 Endoscopic Retrograde Cholangiopancreatography
16.2 Overview of Procedure
16.3 General Diagnostic Techniques
16.3.1 Biliary Cannulation
16.3.2 Sphincter of Oddi Manometry
16.4 General Therapeutic Techniques
16.4.1 Biliary Sphincterotomy
16.4.2 Endoscopic Papillary Balloon Dilation
16.5 Accessory Devices and Techniques
16.6 Accepted Indications
16.7 Procedure-Specific Quality Measures
16.8 Procedure-Specific Training Requirements
16.9 Procedure-Specific Complications
17.2 Overview of Cholangioscopy
17.3 General Diagnostic Techniques
17.3.1 Two-Operator Systems: Mother-Baby Scopes
17.3.2 Single-Operator System: SpyGlass Cholangiopancreatoscopy
17.3.3 Direct Cholangioscopy
17.4 Accessory Devices and Techniques
17.4.1 Confocal Microscopy
17.4.2 Lithotripsy Probes
17.4.3 Intraductal Biopsy Forceps
17.5 Accepted Indications
17.5.1 Evaluation of Indeterminate and Malignant Biliary Strictures
17.5.2 Diagnosis and Management of Choledocholithiasis
17.5.3 Photodynamic Therapy of Cholangiocarcinoma
17.6 Complications of Cholangioscopy
18 Advanced Imaging Methods
18.2 High-Definition Endoscopes
18.3 Virtual Chromoendoscopy
18.5 Flexible Spectral Imaging Color Enhancement
18.6 i-Scan and Optical Enhancement
18.7 Clinical Application of Virtual Chromoendoscopy
18.9 Clinical Application of Chromoendoscopy
18.10 Confocal Laser Endomicroscopy
18.12 Endoscope-Based CLE
18.13 Clinical Application
18.14 Optical Coherence Tomography
19 The Contribution of Histopathology to Endoscopy
19.2 Clinical Impact of Histopathology by Segment within the Gastrointestinal Tract
19.3 Endoscopic Resections
20 Endoscopic Ultrasonography
20.2 Overview of the Procedure
20.3 General Diagnostic and Therapeutic Techniques
20.3.1 Conditions of Implementation
20.3.2 Endoscopes and Probe
20.3.3 EUS Semiology of the Bowel Wall
20.4 Accessory Devices and Techniques
20.4.2 Contrast-Enhanced EUS
20.4.3 Needles and EUS-Guided Sample
20.5 Accepted Indications
20.8 Complications and Prevention
20.8.1 Noninterventional EUS
20.8.3 Interventional EUS
21 Hybrid, Natural Orifice, and Laparoscopy-Assisted Endoscopy: New Paradigms in Minimally Invasive Therapy
21.5 Laparoscopy-Assisted Endoscopy
21.6 Laparoscopy-Assisted Endoscopic Resection
21.7 Endoscopy-Assisted Laparoscopic Resection
21.8 Combined Laparoscopic–Endoscopic Resection
IV Upper Gastrointestinal Tract Disease
22 Gastroesophageal Reflux Disease and Infectious Esophagitis
22.1 Diagnostic Approaches
22.2 Therapeutic Approaches
22.4 Endoscopic Therapy for GERD
22.5 Infectious Esophagitis
22.5.1 Candida Esophagitis
22.5.2 Herpes Simplex Virus Esophagitis
22.5.3 Cytomegalovirus Esophagitis
23 Barrett's Esophagus and Early Neoplasia
23.1 Diagnostic Work-Up for Barrett’s Esophagus and Early Neoplasia
23.1.1 General Approach to Barrett’s Esophagus
23.1.2 Endoscopic Imaging of Barrett’s Esophagus
23.2 Endoscopic Surveillance for Barrett’s Esophagus
23.3 Management of Dysplasia and Early Cancer in Barrett’s Esophagus
23.3.1 Indications for Endoscopic Treatment
23.3.2 Endoscopic Treatment Techniques
23.3.3 Current Guidelines for Endoscopic Treatment and Subsequent Follow-Up
23.4 Areas of Uncertainty, Experimental Techniques, and Research
23.4.1 Biological Markers in Barrett’s Esophagus
23.4.2 Low-Risk Submucosal Cancer
23.4.3 Novel Developments in Endoscopic Ablation
24 Squamous Neoplasia of the Esophagus
24.1.1 Epidemiology and Risk Factors
24.1.2 Precursor Lesions for Squamous Neoplasia
24.2 Diagnostic Approaches
24.2.1 Nonendoscopic Techniques
24.2.2 Endoscopic Techniques
24.3 Treatment for Squamous Neoplasia of the Esophagus
24.3.1 Endoscopic Resection
24.4.1 Radiofrequency Ablation
24.4.3 Other Ablative Techniques
24.5 Areas of Uncertainty, Experimental Techniques, and Research
25 Benign Esophageal Strictures and Esophageal Narrowing Including Eosinophilic Esophagitis
25.2 Diagnostic Approaches
25.2.1 General Approach Including Causes, Symptoms, and Diagnosis
25.3 Classification System
25.4 Therapeutic Approaches
25.4.1 Standard Technique
25.4.2 Variations of Standard Techniques
25.5 Novel Diseases Causing Esophageal Stricturing
25.5.1 Eosinophilic Esophagitis
25.6 Post–Endoscopic Resection
25.7 Areas of Uncertainty, Experimental Techniques, and Research
26.1.4 Clinical Presentation
26.2 Diagnostic Approaches
26.2.1 General Approach Including Equipment and Techniques
26.2.2 Achalasia Subtypes
26.2.3 Guidelines and Systematic Reviews
26.3 Therapeutic Approaches
26.3.1 Standard Techniques
26.3.2 Guidelines and Systematic Reviews
26.4 Areas of Uncertainty, Experimental Techniques, and Research
27 Advanced Esophageal Cancer
27.2 Diagnosis and Classification
27.2.1 Malignant Dysphagia
27.2.5 Esophagorespiratory Fistulas
28 Peptic Ulcer Disease and Bleeding, Including Duodenal Ulcer
28.2 Diagnosis of Peptic Ulcer Disease and Bleeding
28.3 Choice of Instrument for Peptic Ulcer Bleeding
28.4 Therapeutic Modalities for Peptic Ulcer Bleeding
28.4.3 Mechanical Therapy
28.4.4 Topical Hemostatic Powders
28.5 New Hemostatic Modalities
28.5.1 Endoscopic Suturing
28.5.2 Endoscopic Ultrasound–Guided Angiotherapy
29 Gastric Cancer Including Early Neoplasia and Preneoplastic Conditions
29.2.2 Endoscopic Technique
29.2.3 Knowledge for Diagnosis
29.3 Therapeutic Approach
29.3.1 Principle of Endoscopic Resection
29.3.2 Indication for Endoscopic Resection
29.3.3 Clinical Management after Endoscopic Resection
29.5 Repeat as Needed for Each Condition
30 Obesity: Endoscopic Approaches
30.2 Obesity: Endoscopic Approaches
30.3 Diagnostic Approach and the Multidisciplinary Obesity Center Concept
30.3.1 General Approach, Equipment, and Techniques
30.3.2 Therapeutic Approaches: Currently Available Techniques
30.3.3 Gastric Techniques
30.3.4 Small Bowel Techniques
30.3.5 Endoscopic Revision of Prior Gastric Bypass
30.3.6 Other Postoperative Issues That Lead to Weight Gain and May Require Endoscopic Intervention
30.3.7 Guidelines and Systematic Reviews
30.3.8 Experimental Techniques
31 Small Intestinal Diseases Beyond the Duodenum
31.2 Suspected Small Bowel Bleeding
31.2.1 Diagnostic Approaches
31.2.2 Therapeutic Approaches
31.3 Small Bowel Crohn’s Disease
31.4 Dilation of Small Bowel Stricture
31.6 Malabsorption Disorders of the Small Bowel
31.6.1 Diagnostics and Therapeutics
31.7 Small Intestinal Infections
31.9 Miscellaneous Conditions
32 Sporadic Neoplastic Polyps of the Duodenum and Ampulla
32.2 Ampullary Neoplastic Polyps
32.2.1 Types of Ampullary Polyps
32.2.2 Clinical Manifestations
32.2.4 Management of Ampullary Neoplasms
32.2.5 Endoscopic Ampullectomy
32.2.6 Endoscopic Outcomes: Clinical Success, Recurrence Rates
32.4 Nonampullary Sporadic Neoplastic Duodenal Polyps
32.4.1 Types of Nonampullary Duodenal Polyps
32.4.3 Management of Nonampullary Duodenal Adenomas
32.4.4 Outcomes of Endoscopic Mucosal Resection
32.4.6 Post–Endoscopic Mucosal Resection Care
32.4.7 Role of Endoscopic Submucosal Dissection
33 Malabsorption and Food Allergy/Intolerance
33.2.1 Water-Immersion Technique
33.3 Chromoendoscopy and Magnification Endoscopy
33.5 Confocal Laser Endomicroscopy
33.6 Optical Coherence Tomography
33.7 Device-Assisted Enteroscopy
33.8 Selected Small Bowel Diseases
33.8.3 Small Bowel Bacterial Overgrowth
33.8.4 Sprue-Like Enteropathy Associated with Olmesartan
34 Portal Hypertension, Varices, Gastropathy, and Gastric Antral Vascular Ectasia
34.2 Portal Hypertension: What Do We Need to Know?
34.2.1 Pathophysiology of Portal Hypertension
34.2.2 Noncirrhotic Portal Hypertension
34.2.3 Cirrhotic Portal Hypertension: Natural History, Risk Stratification, and Individualizing Care
34.3 Diagnosis of Portal Hypertension
34.3.1 Hepatic Venous Pressure Gradient
34.4 Treatment of Portal Hypertension
34.4.1 Primary Prophylaxis
34.4.2 Management of Acute Variceal Bleeding
34.5 Secondary Prophylaxis
34.6 Management of Treatment Failure
34.7 New Modality in Management of AVB: Hemospray
34.8 Management of Gastric Varices
34.9 Management of Ectopic Varices
34.10 Portal Hypertensive Gastropathy and Gastric Antral Vascular Ectasia
34.11 Areas of Uncertainty, Experimental Techniques, and Research
V Lower Gastrointestinal Tract Disease
35 Colorectal Polyps and Cancer Screening/Prevention
35.2 Polyp Classification and Polyp Cancer Sequences
35.3 Conventional Adenomas
35.3.1 Low-Risk versus Advanced Conventional Adenomas
35.3.2 Shape and Colonic Distribution of Conventional Adenomas
35.3.3 Surface Features of Conventional Adenomas
35.3.4 Resection of Conventional Adenomas
35.4 Serrated Class Lesions
35.4.1 Terminology and Histology
35.4.2 Endoscopic Presentation
35.4.3 Resection of Serrated Lesions
35.5 Colorectal Cancer Screening
35.5.1 Approaches to Offering Screening
35.5.2 Factors That Affect Colorectal Cancer Risk
35.5.3 Choices of Individual Screening Tests
35.5.4 Surveillance after Cancer Resection
36 Advanced Colorectal Polyps and Early Cancer Resection
36.2 Technical Aspects and Preparation
36.2.1 Patient Preparations
36.2.2 Techniques of Endoscopic Resection
36.2.3 Equipment Required
36.4.1 Endoscopic Mucosal Resection
36.4.2 Endoscopic Submucosal Dissection
36.5.1 EMR of LSLs at the Anorectal Junction
36.5.2 EMR of LSLs at the Ileocecal Valve
36.5.3 EMR of Circumferential LSLs
36.5.4 EMR of Lumen Filling Lesions
36.5.5 EMR of Periappendiceal LSLs
36.5.6 EMR of Multiple Recurrent LSLs
36.5.7 Sessile Serrated Lesions
36.5.8 Endoscopic Resection of Large Pedunculated Lesions
36.6 Endoscopy versus Surgery
36.7.1 Intraprocedural Bleeding
36.7.2 Clinically Significant Postendoscopic Bleeding
36.7.4 Postprocedural Pain
36.8 Residual and Recurrent Disease
36.8.1 Recurrence and EMR
36.8.2 Techniques at the Initial EMR to Prevent Recurrence
36.8.3 Triaging Patients to Follow Up Based on Risk of Recurrence
36.8.4 Accurate Assessment of the Post-EMR Scar
36.8.5 Endoscopic Treatment of Post-EMR Recurrence
36.9 Future Direction of ER
37 Inheritable Cancer Syndromes
37.2 Nonpolyposis Syndromes
37.3.1 Familial Adenomatous Polyposis
37.3.2 Attenuated Familial Adenomatous Polyposis
37.3.3 MUTYH-Associated polyposis
37.3.4 Serrated Polyposis Syndrome
37.3.5 Hamartomatous Polyposis Syndromes
38 Inflammatory Bowel Disease and Microscopic Colitis
38.2 Endoscopic Characteristics of IBD
38.2.3 Small Bowel Imaging
38.2.4 Endoscopic Ultrasonography
38.2.5 Endoscopic Retrograde Cholangiopancreatography
38.3 Endoscopy in Established IBD
38.4 Endoscopic Evaluation of IBD Disease Activity
38.4.2 Ulcerative Colitis
38.5 Endoscopy after Surgery
38.6 Endoscopic Surveillance in IBD
38.7 Therapeutic Endoscopic Approaches in IBD
39 Lower Intestinal Bleeding Disorders
39.2.2 Clinical Course and Prognosis
39.3.2 Physical Examination
39.3.3 Laboratory Studies
39.3.5 Nonendoscopic Methods
39.4 Differential Diagnosis
39.4.5 Anorectal Diseases
39.5.1 Initial Resuscitation
39.8.1 Hemospray (Cook Medical) TG 325
39.8.2 EndoClot (EndoClot Plus Inc.)
39.8.3 Ankaferd Blood Stopper (Ankaferd Health Products)
39.9.1 Over-the-scope Clip System (OTSC) (Ovesco, Tübingen, Germany)
39.10 Differential Endoscopic Therapy
39.10.2 Vascular Diseases
39.10.5 Bleeding after Colonic Polypectomy
40.2.2 Perianal Abscesses
40.3.1 Chlamydial Infection
40.3.2 Gonococcal Proctitis
40.3.3 Herpes Simplex Virus
40.3.5 Lymphogranuloma Venereum
40.4.1 Ischemic Proctitis
40.4.2 Radiation Proctitis
40.5.2 Anal Intraepithelial Neoplasia
40.6.3 Solitary Rectal Ulcer Syndrome
VI Biliopancreatic, Hepatic, and Peritoneal Diseases
41 Benign Biliary Disorders
41.2 Postoperative Biliary Stricture
41.3 Chronic Pancreatitis and Biliary Strictures
41.4 Primary Sclerosing Cholangitis
42 Malignant Biliary Disease
42.2.1 Radiologic Imaging
42.2.2 Endoscopic Retrograde Cholangiopancreatography
42.2.3 Fluorescence In-Situ Hybridization
42.2.5 Endoscopic Ultrasound-Fine Needle Aspiration
42.2.6 Intraductal Ultrasound
42.2.7 Probe-based Confocal Laser Endomicroscopy
42.3 Classification Systems
42.4 Guidelines and Systematic Reviews
42.5 Therapeutic Approaches
42.5.1 Standard Techniques
42.5.2 Liver Transplantation
42.5.3 Variation of Standard Techniques
42.6 Guidelines and Reviews
42.7 Areas of Uncertainty
43 Acute and Chronic Pancreatitis
43.2 Diagnostic Approaches
43.2.2 Equipment and Techniques
43.2.3 Guidelines and Systematic Reviews
43.3 Therapeutic Approaches
43.3.1 Standard Techniques
43.3.2 Guidelines and Systemic Reviews
43.4 Areas of Uncertainty, Experimental Techniques, and Research
43.4.1 Diagnostic Procedures
43.4.2 Therapeutic Procedures
44 Pancreatic Cancers and Cystic Neoplasms
44.2.1 Ductal Adenocarcinoma of the Pancreas
44.2.2 Pancreatic Neuroendocrine Tumors
44.3 Cystic Lesions of Pancreas
44.3.1 Nonneoplastic Cysts
44.3.2 Pancreatic Cystic Neoplasms
45 Subepithelial Tumors of the Gastrointestinal Tract
45.2.1 Gastrointestinal Stromal Tumors
45.2.4 Other Subepithelial Lesions of the Gastrointestinal Tract
45.3 Risk Stratification of Subepithelial Tumors
45.4 Methods for Tissue Acquisition
45.4.1 Endoscopic Ultrasound-Guided Fine-Needle Aspiration
45.4.2 Endoscopic Ultrasound-Guided Fine-Needle Biopsy and Trucut Biopsy
45.4.3 Other Tissue Acquisition Techniques
45.5 Management of Subepithelial Lesions
45.6 Endoscopic Resection of Subepithelial Tumors
46 Gastrointestinal Foreign Bodies
46.2 Clinical Epidemiology
46.2.1 Overview of Pathophysiology
46.3 Patient Presentation
46.4.2 Pharmacologic therapies
46.4.3 Endoscopic accessories and interventions
46.4.4 Esophageal food impaction
46.4.5 Sharp foreign bodies
46.4.6 Coins and button batteries
46.4.8 Rectal foreign bodies
46.6 Conclusion and Future Trends
Gastroenterological Endoscopy
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