3.0 STANDARD ENDOSCOPIC ANATOMY
The anatomic sites are divided into separate sections
according to the endoscopic examination that is performed. This is an arbitrary grouping
and is designed to facilitate review. When necessary figures are included to more
precisely define the location.
3.1 Standard Anatomic sites
3.1.1 Upper gastrointestinal tract sites
The following table shall be used to define sites for findings in the upper gastrointestinal tract.
Table 1. Sites for location of findings in the upper gastrointestinal tract.
| ORGAN | SITE | MODIFIER |
| Esophagus | ||
| Crico-pharyngeus | ||
| Upper third | ||
| Middle third | ||
| Lower third | ||
| Cardia | ||
| Whole esophagus | ||
| Anastomosis | ||
| Stomach | ||
| Cardia | ||
| Fundus | ||
| Body | ||
| Incisura | ||
| Antrum | ||
| Pre-pyloric | ||
| Pylorus | ||
| Whole stomach | ||
| Anastomosis | ||
| Pyloroplasty | ||
| Duodenum | ||
| Bulb | ||
| Anterior | ||
| Posterior | ||
| Proximal | ||
| Distal | ||
| 2nd part of the duodenum | ||
| Area of papilla | ||
| Anastomosis | ||
| Whole examined duodenum | ||
| Jejunum | ||
| Afferent jejunal loop | ||
| Efferent jejunal loop | ||
| Jejunal crest |
3.1.2 Lower gastrointestinal tract sites
The following table shall be used to define sites for findings in the lower gastrointestinal tract.
Table 2. Sites for location of findings in the lower gastrointestinal tract.
| ORGAN | SITE |
| Colon | |
| Anus | |
| Rectum | |
| Sigmoid | |
| Descending | |
| Splenic | |
| Transverse | |
| Hepatic | |
| Ascending | |
| Cecum | |
| Ileo-cecal valve | |
| Stoma | |
| Whole colon | |
| Anastomosis | |
| Rectal Pouch | |
| Ileum |
3.1.3 ERCP sites
The following table shall be used to define sites for findings on ERCP.
Table 3. Sites for location of findings on ERCP.
| ORGAN | SITE | MODIFIER |
| Pancreas | ||
| Whole | ||
| Head | ||
| Body | ||
| Tail | ||
| Main duct | ||
| Accessory duct | ||
| Branches | ||
| Biliary System | ||
| Papilla | ||
| Biliary-pancreatic junction | ||
| Main duct | ||
| Whole | ||
| Lower third | ||
| Middle third | ||
| Upper third | ||
| Cystic duct | ||
| Bifurcation | ||
| Liver ducts | ||
| Left main | ||
| Right main | ||
| Left intrahepatic branches | ||
| Right intrahepatic branches | ||
| All intrahepatic branches | ||
| Gallbladder |
3.2 Examination characteristics
3.2.1 Principles and scope
The characteristics of examination refer to the extent and limit of the examination. Extent of the examination is defined as the anatomic extent of the examination. Limit of the examination is defined as any limitation that impedes adequate execution of the procedure. It is recognized that there is some overlap in the concept of extent and limit. The intent of this section is to convey in an explicit manner those characteristics of the examination that affect the completeness of the examination, any limitations that prevent a complete examination and any maneuvers necessary to execute a complete examination.
Extent of the examination is specified by the furthest anatomic site reached or a list of the anatomic sites visualized. For colonoscopy, if the cecum is reached, then the anatomic site "cecum" specifies the extent of examination. For ERCP, if only the biliary tree is visualized, then it is necessary to specify that the extent of the examination was the biliary tree.
Limit of examination is specified by any restrictions on the examination that are the result of inadequate preparation, anatomic anomalies or barriers. In colonoscopy the quality of bowel cleansing is a major factor for the quality of the procedure, especially when small and flat lesions are sought. Poor preparation is considered a limit of the examination. Stenosis of the segment of the gastrointestinal tract that requires intervention to complete an examination is also considered a limit of the examination. For example, stenosis precludes the passage of the endoscope but dilation permits the instrument to be advanced. This is also the case for ERCP, where part of the endoscopic report should describe the various maneuvers which were performed to obtain cannulation and/or opacification of the ducts.
3.2.2 List of terms describing the extent of examination
The following tables shall be used to define the extent and limits of the examination.
Table 4. Terms
describing the extent and limits of the examination
for Upper Gastrointestinal Endoscopy and Colonoscopy.
| TERM | ATTRIBUTES | ATTRIBUTE VALUES | SITES |
| Preparation | Method | Specify | |
| Quality | Excellent | Site(s) | |
| Adequate | |||
| Inadequate: examination completed | |||
| Inadequate: precluding a complete examination | |||
| Extent of Examination | Location | Site(s) | |
| Limitation | Reason | Adhesion | Site(s) |
| Colonic loop | |||
| Stenosis | |||
| Poor preparation | |||
| Patient Unstable: Specify | Site(s) | ||
| Equipment Malfunction: Specify |
Table 5. Terms describing the extent and limits of the examination for ERCP.
| TERM | ATTRIBUTES | ATTRIBUTE VALUES | SITES |
| Access to the Papilla | Access | Not reached | |
| Not found | |||
| Unaccessible | |||
| Reason | Specify | ||
| Cannulation | Duct | Pancreatic | |
| Biliary | |||
| Result | Successful: Deep | ||
| Successful: Superficial | |||
| Failed | |||
| Not attempted | |||
| Submucosal Injection | |||
| Method | Free cannulation | ||
| Over a guide-wire | |||
| After precut | |||
| Device | Cannula | ||
| Metal tip cannula | |||
| Papillotome | |||
| Balloon catheter | |||
| Manometry catheter | |||
| Opacification | Duct | Pancreatic | |
| Biliary | |||
| Result | Successful: Complete | ||
| Successful: Partial | |||
| Failed | |||
| Not attempted | |||
| Reflux of contrast medium | |||
| Extravasation |
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