GI Lab training

Sphincterotome (ERCP function)

Enters the duct and uses electrosurgery to cut the papillary sphincter, creating access for treatment.

Sphincterotomy (patient benefit)

Enables stone extraction or other duct treatment to help relieve an obstruction.

Autotome pre-opening verification requirements

Exact catheter model, guidewire diameter and length, scope channel, electrosurgical cable, and planned task.

ERCP extraction balloon (primary use)

Inflates above material in a duct and draws it toward the outlet to sweep out stones or sludge.

Extraction balloon vs. Dilation balloon

Extraction balloons sweep material out; dilation balloons stretch narrowings. Inflation limits and intended uses differ.

Importance of identifying extraction-balloon ports before use

Guidewire, contrast, and inflation paths perform different jobs; mixing them up prevents function or causes injury.

Key requirement during sphincterotome to extraction balloon exchange

Preserving guidewire access to the intended duct while removing the outgoing catheter and advancing the next.

Team communication during ERCP accessory exchange

Who controls the wire, which device is moving, and whether resistance or wire movement occurs.

External guidewire management during ERCP exchange

Keep controlled on a designated clean surface, protected from kinking and contamination; never tuck under an arm or clamp with unapproved instruments.

Reasons to exchange an extraction balloon back to a sphincterotome

To allow further cannulation, contrast assessment, or additional sphincter therapy.

Difference between short-wire and long-wire ERCP exchanges

Wire exit, locking method, and amount of wire outside the patient differ.

Protocol for unexpected resistance during ERCP exchange

Stop movement, notify the doctor, and reassess device alignment and wire position without forcing.

Hurricane biliary dilation balloon (function)

Stretches a selected biliary narrowing so the duct can drain or accommodate subsequent treatment.

Purpose of the pressure gauge on a balloon inflation device

Balloon diameter depends on its labeled pressure relationship; operators must stay within exact specifications.

Checks required before dilation-balloon inflation

Correct balloon size and position, prescribed inflation medium, compatible inflation device, and model pressure limit.

Indications for biliary stent placement

Maintains bile drainage across a blockage or helps divert bile past a leak.

Roles of wire and pusher in plastic biliary stent placement

The wire guides the route while the pusher advances the stent under endoscopic and fluoroscopic guidance.

Essential handoff information following biliary stent placement

Stent type, size, location, and the doctor's removal or exchange plan.

Indications for pancreatic duct stent placement

Supports pancreatic drainage, treats a duct problem, or reduces post-ERCP pancreatitis risk in selected patients.

Pre-loading verification for pancreatic stents

Diameter, length, flanges, shape, guidewire compatibility, and release method.

Prophylactic pancreatic stent (pancreatitis risk)

Reduces risk in selected cases, but does not eliminate it; requires follow-up for confirmation of passage or removal.

Equipment goal during emergency GI bleeding cases

Restore a usable view and have selected hemostasis devices ready while resuscitation and airway management occur.

Tools for esophageal food bolus or foreign body removal

Retrieval net, grasper, snare, and protective hood or overtube when appropriate.

Rationale for having multiple hemostasis device types available

Bleeding patterns and tissue vary; doctors may need mechanical, thermal, injection, or topical options.

Mechanism of epinephrine injection for active ulcer bleeding

Local vasoconstriction and injection pressure slow bleeding and improve visibility for secondary treatment.

Definitive status of epinephrine injection for peptic ulcer bleeding

It is not definitive alone; it should be paired with a second method (e.g., clip or contact thermal therapy).

Pre-passage safety checks for an injection catheter

Ordered solution and concentration, syringe labeling, priming instructions, and ensuring needle is fully retracted.

Purpose of tattooing a GI lesion or resection site

Leaves a visible landmark to help a subsequent endoscopist or surgeon locate the site.

Tattoo position precaution relative to future resection

Injecting into or directly under a lesion causes fibrosis that complicates lifting/dissection; inject adjacent to site.

Required documentation details for an endoscopic tattoo

Agent used, site, relation to lesion, amount injected, and photos or clear anatomical description.

Eleview (primary indication)

Submucosal injection agent used to create a cushion beneath a lesion for endoscopic removal.

Submucosal lifting (benefit during resection)

Separates the target lesion from the deep muscle layer, enabling safer capture or dissection.

Eleview 10 mL container volume interpretation

Refers to supply package size; actual injected volume is determined by the physician based on the lesion.

EndoFLIP (primary measurement parameters)

Diameter/cross-sectional area and pressure of a fluid-filled balloon to assess GI junction opening.

EndoFLIP clinical benefit for swallowing symptoms

Provides details on junction opening mechanics and esophageal motility to guide treatment planning.

EndoFLIP distensibility index (definition & units)

Cross-sectional area divided by balloon pressure, measured in $\text{mm}^2/\text{mmHg}$.

EF-322N vs. EF-325N (EndoFLIP catheters)

EF-322N is a $16\,\text{cm}$ measurement catheter; EF-325N is an $8\,\text{cm}$ measurement catheter.

EndoFLIP vs. EsoFLIP

EndoFLIP catheters assess opening mechanics; EsoFLIP catheters are designed for dilation.

Protocol for EndoFLIP fill levels and removal

Follow exact console/catheter instructions, confirm study protocol, and complete prescribed deflation sequence before removal.

ERCP supply organization categories

Access (catheter/wire), Imaging (contrast/fluoroscopy), Therapy (extraction/dilation/stenting), Rescue (backup equipment).

ERCP scope distal cover and elevator checks

Verify exact model-specific required cover, attachment check, inspection, and reprocessing instructions.

Radiation safety setup during ERCP

Wear required protective lead equipment/dosimeter and follow room radiation-safety procedures during fluoroscopy.

Pre-procedure check for scope suction and irrigation

Maintains clear visibility and fluid removal; catches connection or functional failures prior to patient insertion.

Purpose of a bite block in upper endoscopy

Protects the scope and patient teeth while maintaining open oral access.

Simethicone water bottle policy

Should not be added by routine habit; follow only approved route, dilution, and unit/equipment reprocessing policies.

Essential pre-procedure equipment function checks

Image and light, air/$\text{CO}_2$, irrigation, suction, and electrosurgical or specialty systems.

Pre-activation foot pedal verification

Prevents accidental activation because different pedals control different devices or operational modes.

Essential time-out information for the assistant

Patient ID, planned procedure, alerts, expected therapy, and specific equipment or specimen requirements.

Bravo capsule (diagnostic function)

Records esophageal pH over an extended period to evaluate acid exposure and symptom correlation.

Bravo capsule measurement limitation

Does not directly detect non-acid reflux events (requires combined pH-impedance testing).

Importance of recorder setup and patient diary in Bravo testing

Correlates pH changes directly with patient activities, meals, posture, and symptoms.

Bravo capsule MRI safety restriction

MRI is restricted for 30 days post-procedure unless capsule passage is verified.

Authority for acid-suppression medication holds during Bravo testing

Determined exclusively by the ordering clinician (on- or off-treatment study protocol).

PolyLoop (pedunculated polyp resection)

Detachable nylon loop that tightens around the stalk to prevent or control bleeding.

PolyLoop HX-400U-30 handling precautions

Do not force slider against resistance; keep sheath straight; avoid pulling yellow joint away to prevent premature tightening.

Required backup equipment for PolyLoop HX-400U-30

Specified Olympus loop cutter.

Purpose of immediate post-procedure bedside precleaning

Prevents soil from drying inside channels, facilitating subsequent manual cleaning.

Does bedside precleaning make an endoscope ready for reuse?

No; it must still undergo leak testing, manual cleaning, high-level disinfection/sterilization, drying, and proper storage.

Scope reprocessing variation across models (CF, PCF, GIF, SIF, TJF)

Cleaning steps cannot be shared across models because channels, valves, adapters, and distal designs differ.

Extra channels requiring attention during EUS scope cleaning

Balloon-related channels and the elevator-wire channel (e.g., GF-UCT180).

Two-stage EUS scope valve cleaning requirement

Operating only one stage leaves separate required flow paths untreated.

Action required if pre-use inspection reveals blocked EUS channel

Remove scope from clinical service immediately and report following facility escalation and manufacturer guidance.

X-Tack system (function)

Places small helical anchors joined by suture to pull GI tissue together across resection defects.

Role of the cinch in X-Tack closure

Secures tensioned suture and cuts excess suture to maintain tissue approximation.

X-Tack 4-tack system configuration

One tack is preloaded on delivery catheter, and three additional tacks are provided as kit reloads.

Pre-selection verification for X-Tack cinch

Verify exact gastric/colonic system, working length, and current compatible cinch part number.

X-Tack system limitations

Not indicated for actively bleeding ulcers; relies on tack approximation, not full-thickness needle suturing.

C2 CryoBalloon ablation (mechanism)

Freezes selected abnormal GI surface tissue via contact balloon containing nitrous oxide.

C2 CryoBalloon vs. truFreeze spray cryotherapy

C2 uses nitrous oxide inside a balloon; truFreeze sprays liquid nitrogen directly with separate gas venting.

Pre-procedure checks for C2 CryoBalloon ablation

Verify exact catheter/controller, scope channel compatibility, target area, and specific dosing/thawing protocol.

OverStitch system (primary capability)

Places endoscopic full-thickness or partial-thickness sutures for tissue approximation.

Tissue helix role in endoscopic suturing

Engages and draws tissue into the suturing device to allow accurate tissue bites.

OverStitch dual-channel requirement

Legacy OverStitch requires a dual-channel scope; OverStitch NXT works with compatible single-channel endoscopes.

OverStitch compatibility checks

Match system generation, approved scope model, suture type, tissue-acquisition accessory, and cinch.

Indication for botulinum toxin injection at lower esophageal sphincter

Relaxes sphincter to temporarily improve dysphagia in achalasia patients unfit for definitive therapy.

ACG guideline recommendation on intrapyloric Botox for gastroparesis

Recommends against routine intrapyloric injection based on clinical trial evidence.

Missing element in a Botox order specified only in mL

Does not state drug dose in units; exact units, dilution, and concentration must be verified.

Mechanism of cyanoacrylate glue for gastric varices

Rapidly solidifies within the varix to occlude blood flow and arrest bleeding.

Major risks of variceal cyanoacrylate glue injection

Systemic embolization, catheter adhesion, and scope damage.

Safety rule regarding cyanoacrylate glue mixing recipes

Never use unvalidated cards; verify precise product, indication, catheter, preparation, and rescue plan.

Captivator EMR (primary indication)

Ligation-assisted mucosal resection in the upper gastrointestinal tract.

Steps of band-assisted EMR

Target tissue is drawn into cap, banded to form a pseudopolyp, and resected using a snare.

Specimen handling requirement following Captivator EMR

Retrieve and label carefully so pathology can assess lesion margins and completeness of removal.

Esophageal variceal ligation (mechanism of hemostasis)

Elastic band compresses the captured varix, arresting blood flow through the treated segment.

Reason for multiple variceal banding sessions

Multiple or residual varices require staged treatment to achieve complete eradication.

Pre-setup checks for variceal banding kits

Exact kit model, scope fit, band count, loading mechanism, and latex allergy status.

Purpose of an endoscopic overtube during foreign body retrieval

Provides a protected passage for repeated scope passes and protects mucosa from injury.

Does an overtube replace airway protection?

No; aspiration risk and intubation needs are separate clinical decisions.

Overtube pre-procedure checks

Correct length, scope compatibility, structural integrity, and proper lubrication/assembly.

Foreign-body retrieval hood (purpose)

Covers sharp or irregular objects during withdrawal to protect the esophageal mucosa.

Pre-insertion checks for foreign-body retrieval hoods

Verify secure fit to prevent vision impairment, detachment, or failure to cover the object.

Safety check for retrieval hoods in latex-allergic patients

Check explicit latex labeling; do not assume hoods are latex-free.

OTSG Xcavator (primary indication)

Removal of bulky material like necrotic tissue, large clots, food boluses, or foreign bodies.

OTSG Xcavator working channel advantage

Operates via an external drive system, leaving the scope channel free for suction or irrigation.

Difference between OTSG Xcavator and OTSC

OTSG Xcavator is a large grasping device; OTSC is an over-the-scope hemostatic/closure clip.

Over-the-scope clip (OTSC) tissue capture mechanism

Draws a large volume of tissue into a transparent cap prior to clip release.

Role of Twin Grasper or Anchor in OTSC deployment

Accessories that grasp and pull target tissue into the cap prior to firing.

Final safety check before releasing an OTSC

Confirm target tissue is correctly captured, non-target tissue is excluded, and doctor confirms readiness.

Full-Thickness Resection Device (FTRD) mechanism

Draws tissue into cap, deploys OTSC at base to seal wall, and resects tissue above clip with pre-loaded snare.

Clinical benefit of FTRD

Enables full-thickness endoscopic resection of lesions unsuitable for EMR/ESD, avoiding surgical resection.