Upper GI Endoscopy

The CD is divided into several sections: Esophagoscopy, Gastroscopy, Duodenoscopy, and Biopsy/Brush Cytology. In addition, 3 Clinical Cases are presented in which it is demonstrated how endoscopy was helpful in reaching a diagnosis. The setup of the presentation is logical and each section can be studied on its own. A minor disadvantage of this approach is that if modules are taken one after the other, a lot of repeat information is shown, which can become tedious. The ability to maneuver around the learning module is good. Several direct paths leading to the desired segment of the module can be selected. The description of the actual endoscope movements is adequate. Within the program, regular reference is made to another CD ROM from Lifelearn, namely Introduction to Flexible Endoscopy where more instruction on handling and setup of the endoscope is provided. The description for the technique of performing an endoscopic examination is adequate but, at times, awkward. For example, the advice to complete a total gastroscopy prior to advancement into the duodenum is, in my opinion, ill advised; it will result in an increased chance of closure of the pylorus in response to the gastric distention and stimulation. Subsequent passage into the duodenum past the pyloric sphincter will become much more difficult compared with completing the gastroscopy once the duodenoscopy has been completed. In my opinion, to see an open pyloric sphincter during scoping (which stays open as happens in the video demonstration) is rare, a closed pyloric sphincter is much more common. The latter can be a real challenge to pass through with the endoscope, a subject not discussed in the program. Some findings and interpretations of the clinical cases are open for discussion. For example, the finding of thickened bowel loops on abdominal palpation has, in clinical practice, been fraught with errors. In my opinion, only abdominal ultrasonography can be used as a noninvasive reliable, reproducible method of determining intestinal wall thickness. In another case, a dog with chronic vomiting, the use of H2 blocker therapy was rejected, despite the likely presence of mild esophagitis. On the other hand, the recommended use of sucralfate suspension in a patient with esophagitis is probably of little value. As always, it is advisable to check drug choices and dosages in standard reference text books prior to commencement of therapy. In summary: Upper GI Endoscopy provides an attractive interactive way of demonstrating endoscopy to practitioners. The CD ROM's main function will be to complement wet labs and standard endoscopy texts.