Video clips

Colonscopy - normal colon

This clip demonstrates a normal colonoscopy and starts in the terminal ileum where the delicate villous architecture is well seen.

The colonoscope is withdrawn into caecum. Here at the base of the caecum is the orifice of the appendix. In the tissue surrounding the appendiceal orifice, a speckled pattern of lymphoid aggregates can often be seen.

During the colonoscopy, the endoscopist both insufflates the lumen of the colon with air and aspirates the small amount of liquid that remains from the preparation previously taken by the patient to cleanse the colon. The liquid often has a slightly yellowish tinge of bile.

Backing out of the cecum, a better view of the ileocaecal valve is obtained. It has a rounded slightly yellowish appearance.

Traveling down the colon, a repeating pattern of pouches and folds are seen. These pouches are called haustra and the folds are referred to as the plicae semilunares or simply the semilunar folds.

A word about the colonic tissue itself. The white dots seen throughout the exam are reflections of the colonoscope's light off the tissues and back into the viewing lens. Normally the tissue has this glistening pink hue. Also visible is the delicate vascular plexus of capillaries that nurture the colonic mucosa.

Here in the sigmoid colon, the earliest signs of diverticulosis are visible. These are outpouchings of the mucosa through the muscular layers of the colon and are seen commonly starting in the fifth decade of life. At the end of the exam, in the rectal vault, the colonoscope is retroflexed to provide a complete view of the anal verge where small tumors and internal hemorrhoids may be found.

Contributed by:

Peter B. Kelsey, M.D.
Assistant Professor of Medicine
Harvard Medical School
Massachusetts General Hospital

Colonscopy - removal of a polyp

This 57 year old physician with a strong family history of colon cancer was self referred for a screening colonoscopy.

A small polyp is seen in the cecum and removed by the cold snare technique.

Diverticular disease

The colonoscope is slowly withdrawn during this screening colonoscopy down from the transverse colon, back around the splenic flexure, and down the descending colon, and reveals this finding a colonic diverticula. Diverticulosis is a common, acquired, age-related occurrence affecting over 50% of the western adult population over the age of 50. It is seen rarely in Africa and Asia where the dietary fibre content is traditionally higher. Thus most endoscopits feel that low fibre diets are related to the development of this condition.

Stomach - Helicobacter Pylori Inflammation

Comments: The patient is a 55 year-old woman who presented with dyspepsia. Evaluation was performed with upper endoscopy.

After entering the stomach, subtle mucosal abnormalities were seen in the gastric antrum. Specifically, there was mild, patchy erythema and congestion, as well as granularity and nodularity.

On retroflexion, the incisura as well as the rugal folds appeared normal. There was no evidence of peptic ulcer disease.

Similarly, the duodenal bulb and second portion of the duodenum were normal.

Biopsies proved the antral mucosal abnormalities to be due to Helicobacter pylori.

H. pylori gastritis is one of the causes of dyspepsia. On endoscopy, the diagnosis is suspected with characteristic signs of erythema, most often located in the antrum. Additionally, the mucosa can appear granular, nodular, or can even have a cobblestone pattern.

Diagnosis can be made with biopsy and CLO testing for urease production. As seen here, when tissue with urease-producing H. pylori is added to a urea-rich medium, the phenol indicator turns red. In comparison, if the tissue is H. pylori negative, the medium remains yellow.

An alternative diagnostic strategy is to perform gastric biopsy and histopathologic examination. This is an H&E stained section of gastric mucosa at 400x magnification. Numerous H. pylori organisms can be seen adherent to the mucosal surface.

In summary, H. pylori gastritis is a cause of dyspepsia. It is visually suspected on endoscopy, and can be confirmed with either CLO testing or demonstration of the organisms on gastric biopsy.

Esophagus - Barrett's Esophagus

This 59 year old man with obesity and diabetes mellitus was referred for upper endoscopy to evaluate his history of long standing mild reflux symptoms. On endoscopy, a 6 cm segment of Barrett's esophagus was noted within the distal esophagus. The Barrett's epithelium is recognizable as salmon colored esophageal mucosa that contrasts with the pearly white appearance of the normal esophageal squamous mucosa.