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World J Gastrointest Endosc. Mar 16, 2023; 15(3): 146-152
Published online Mar 16, 2023. doi: 10.4253/wjge.v15.i3.146
Orientation in upper gastrointestinal endoscopy—the only way is up
Arun Sivananthan, Georgina Kerry, Ara Darzi, Kinesh Patel, Nisha Patel
Arun Sivananthan, Ara Darzi, Nisha Patel, Department of Surgery and Cancer, Imperial College London, London W2 1NY, United Kingdom
Georgina Kerry, Liver Intensive Care Unit, King’s College Hospital NHS Foundation Trust, London SE5 9RS, United Kingdom
Kinesh Patel, Gastroenterology, Chelsea and Westminster NHS Foundation Trust, London SW10 9NH, United Kingdom
Author contributions: Sivananthan A, Kerry G drafted and designed the work; Darzi A, Patel N, and Patel K conceptualised, revised and approved the work; Sivananthan A and Kerry G jointly contributed equally to the manuscript; all authors have read and approved the final manuscript.
Institutional review board statement: The study was approved by the Imperial College London institutional review board.
Conflict-of-interest statement: Authors declare no conflict of interest for this article.
Data sharing statement: All data is available as appendices and may be shared.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Arun Sivananthan, BSc, MBBS, Doctor, Department of Surgery and Cancer, Imperial College London, Praed Street, London W2 1NY, United Kingdom. arun.sivananthan@nhs.net
Received: November 21, 2022
Peer-review started: November 21, 2022
First decision: January 2, 2023
Revised: January 15, 2023
Accepted: February 21, 2023
Article in press: February 21, 2023
Published online: March 16, 2023
Processing time: 114 Days and 18.4 Hours
Abstract
BACKGROUND

Oesophagogastroduodenoscopy is the gold standard investigation for the upper gastrointestinal (UGI) tract. Orientation during endoscopy is challenging and United Kingdom training focusses on technical competence and procedural safety. The reported location of UGI pathologies is crucial to post-endoscopic planning.

AIM

To evaluate endoscopists’ ability to spatially orientate themselves within the UGI tract.

METHODS

A cross sectional descriptive study elicited, using an anonymised survey, the ability of endoscopists to orientate themselves within the UGI tract. The primary outcome was percentage of correct answers from all surveyed; secondary outcomes were percentage of correct answers from experienced vs novice endoscopists. Pearson’s χ2 test was applied to compare groups.

RESULTS

Of 188 respondents, 86 were experienced endoscopists having completed over 1000 endoscopies. 44.4% of respondents correctly identified the anterior stomach and 47.3% correctly identified the posterior of the second part of the duodenum (D2). Experienced endoscopists were significantly more likely than novice to identify the anterior stomach correctly [61.6% vs 31.3%, X2 (1, n = 188) = 11.10, P = 0.001]. There was no significant difference between the two groups in identifying the posterior of D2.

CONCLUSION

The majority of endoscopists surveyed were unable to identify key landmarks within the UGI tract. Endoscopic orientation appears to improve with experience yet there are some areas still not well recognised. This has potential considerable impact on post-endoscopic management of patients with posterior duodenal ulcers being more likely to perforate and associated with a higher rebleeding risk. We suggest the development of a consensus statement on endoscopic description.

Keywords: Endoscopy; Orientation; Upper gastrointestinal; Gastric cancer; Duodenal ulcer

Core Tip: The majority of endoscopists surveyed were unable to identify key landmarks within the UGI tract. Endoscopic orientation appears to improve with experience yet there are some areas still not well recognised. This has potential considerable impact on post-endoscopic management of patients with posterior duodenal ulcers being more likely to perforate and associated with a higher rebleeding risk. We suggest the development of a consensus statement on endoscopic description.