Name: HCC 1475-4 - Stomach - Pathology Endoscopy Findings
Uploaded: 2025-04-20T10:23:08.000Z
Duration: 13 min 44 s
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Greetings, let us learn about identifying different pathologies that we encounter in the stomach.

Relative clauses (Restrictive vs. nonrestrictive)

As an endoscopy technician or as an endoscopy nurse, it is important to recognize different pathologies that we see during EGD.

Advanced passive voice

We all should be focusing on the screen whether it is a nurse or a technician in addition to the endoscopist so that when you see pathology you should anticipate what needs to be done and get ready for that.

So in this video what I am going to do is show you normal, that is normal endoscopic anatomy of the stomach and then show a particular pathology so that you can identify what is normal and what is abnormal.

There will be a lot of repetition of normal and it is a good idea to learn what is normal so that is the path that I am going to take.

So here the endoscope has gone into the stomach that is the cardiac and as soon as the endoscopist enters the cardiac what he does is he tries to turn his handle to the left so that the body of the stomach and the fundus of the stomach and the purpose is this is where all the secretions pull, the gastric acid or if there is any residue that pulls down here and the first thing that an endoscopist does is to suction these secretions and empty the stomach so that it avoids the risk of aspiration if the patient coughs or has a retching episode.

So here we emptied the stomach and you see a nice normal upper body of the stomach with a clean gastric rugal force.

Sometimes you may see a light amount of yellow colored fluid that is bile and that is a little amount of bile is not abnormal sometimes we see a little bit of bile that regurgitates from the duodenum into the stomach.

If you see dark bile as you can see here that indicates that there may be and especially if it is a large amount you should suspect that there may be a problem down the stream with some form of obstruction or something abnormal.

In patients where you perform endoscopy for evaluation of upper GI bleeding it is common to see blood pooling in the upper portion of the stomach and you could either see fresh red blood or because of the stomach acid digesting that blood the blood might turn out to be coffee ground like material that is old blood as you see here.

In patients who have diabetes for a long period of time or patients who have obstruction of the stomach for example pancreatic cancer causing duodenal obstruction or obstruction of the outlet of the stomach sometimes the food may not be able to go down and it is retained and that is the food basal that you see this and whenever you see a lot amount of food or fluid in the stomach it is a good idea to come out rather than risk continuing to do the procedure and the risk is aspiration.

Aspiration pneumonia is very dangerous so you want to pull out the stomach ask your anesthesiologist to protect the airway if you need to do the procedure and protection of airway includes endotracheal intubation.

So we have learned about different types of secretions that can collect in the stomach it could be clear bile, dark bile, blood or sometimes food.

So as we go down again we see a normal healthy stomach with rugal folds and if you do not see rugal folds at all then you should suspect gastric atrophy and this gastric atrophy as you can see here is commonly seen in patients with autoimmune gastritis or pernicious anemia.

In this case patients don't have the ability to absorb vitamin B12.

So let us look at it you see the gastric atrophy there are no folds compared to this normal healthy stomach with folds and again no folds and in this case you could see the submucosal blood vessels and if I show you this picture and ask you hey what is this you may say it is colon because colon has this submucosal blood vessels that can be seen.

So but if you see the same thing in the stomach you should suspect gastric atrophy or autoimmune gastritis or pernicious anemia.

If they develop vitamin D B12 deficiency and develop anemia that is pernicious anemia.

So let us look at the fundus of the stomach you can see the folds all the way to the fundus fundus is clear but if there is gastric atrophy this is what it looks like the folds have disappeared and you can see the nice blood vessels of the submucosa.

So when you see submucosal blood vessels in the stomach with no folds suspect gastric atrophy.

So coming back here is the body of the stomach on gastric folds smooth mucosa when the mucosa has a snake skin appearance with intramucosal edema and if it happens in a patient this indicates either gastropathy or gastritis if the patient has cirrhosis of the liver then you should suspect portal hypertensive gastropathy.

So here you notice this snake skin appearance.

So compared to that normal alright and patients who drink heavily or take aspirin or ibuprofen etc for pain then they may develop erosions or gastric erosions and you can see slight streaks of red with a little bit of yellow area in the center.

So as you go down sometimes you see ulcers where there's a break in those folds as you can see here there is a crater here and there's some thickening of the fold at the edge and the folds are converging there with a deep crater.

So when this is a gastric ulcer this could be a benign ulcer due to either Helicobacter pylori infection or because of somebody taking aspirin, buprenorphine or it could be cancer or gastric cancer.

So every gastric ulcer needs to be biopsied.

You biopsy the edges and biopsy the base to see if there is cancer.

A minimum of six biopsies or eight biopsies should be taken from the edge.

Here as you can see here you have lost the folds.

There's a lot of thickening and there's a big ulcer.

Again think about either gastric cancer or in some cases lymphoma can have the similar presentation.

Another case of gastric cancer, big ulcer, thick folds.

So now as we go down to the antrum, this is normal and here you see some ulcers.

Here there are shallow ulcers with sloping edges.

One ulcer here, one ulcer here, one ulcer here and when you have multiple ulcers like this, these tend to be usually benign ulcers and here is a close up of another ulcer as you can see.

Nice clean base, no bleeding site, no bleeding vessel and here is the edge that you take biopsies from.

Another ulcer which is a deep excavating ulcer with a muddy discoloration of the base indicating that the ulcer may have bled and whenever you see an ulcer you should worry about cancer and you should take biopsies.

Every ulcer should have biopsies of the edge and the base, base depending upon how the base looks like, if it is safe to take biopsies from the base to confirm whether it is cancerous ulcer or not.

And every patient with ulcer should also have biopsies of the stomach, antrum and body to check for Helicobacter pylori infection.

So again normal and so it is a nice uniform color and when you see red streaks like you see here, almost like a watermelon stomach, this is known as watermelon stomach usually because of vessels becoming ectatic or this is in the antrum of the stomach.

So gastric, antral, vascular, ectasia or gave.

So these patients tend to lose blood, they develop anemia.

Sometimes incisora can have ulcers as you can see here, this is an ulcer in the incisora and then let us get back to the fundus of the stomach and the fundus of the stomach you are looking for hiatal hernia where this is the hiatal hernia.

Normally the stomach, the scope is supposed to wrap, the fundus of the stomach should wrap, the valve should wrap around the scope.

If there is a gap as you can see here, then you should suspect that there is a hiatal hernia.

Stomach fundus is smooth when you have blobs of vessels, this is gastric fundic varices and these develop in patients with cirrhosis.

So as you come down the stomach you see nice folds and sometimes you see in patients who are taking either Omeprazole, otherwise known as Prilosec or Nixium, they tend to, they can form these benign non-precancerous polyps known as fundic gland polyps.

Usually they are seen as multiple polyps.

Alright, again normal fundic gland polyps.

Alright, I hope this is useful, it is important to be able to recognize the pathology and we will go to the next section later.

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HCC 1475-4 - Stomach - Pathology Endoscopy Findings

recognize

multiple

properly

repetition