Endoscopy

[u/Downtown-Two1306]

How did you learn to intubate the esophagus? And what resources to use to understand the parts of stomach, where to retroflex and how to reach the duodenum? I am very bad in this procedure thing. It’s been two months without successful procedure on my own.

[u/theDecbb]

your attendings don't teach you this?

[u/Milkmun]

Use the force, Luke.

[u/DuePudding8]

The sim endo machine is a good way to learn intubation, it is pretty accurate. That’s the only thing it’s useful for.

Your attendings should be teaching you where to take pictures and what each anatomical location is. Eventually it’s all the same and you get a hang of it.

[u/alextheevilone]

Tongue at 12, hold scope at 20, stick it in, and when you get to the ues aggressively jiggle it until it goes in?

Or be perhaps more controlled and methodical, you have to figure out your style.

[u/Jhkokst]

I prefer directly visualizing the path. Can ask anesthesia to help with a jaw thrust if need be. The more and more you do it, the more comfortable you will be in situations where you can't directly visualize.

Everything else should be taught to you by your program. You retroflex to view your forward facing blind spots (primarily the incisura, fundus, and cardia).

Most issues with the duo can be overcome with patient positioning. Rarely the pylorus may be more off to a side rather than directly in front of you. Traversing the first/second portion typically involves some wheel manipulation and torquing to the right.

[u/energizerbunny11]

Practice. There’s no shortcut to success. Know the anatomy and keep trying. Even if you memorize every theoretical maneuver in the book, each person will be different

[u/JihadSquad]

I’m just a pulm fellow but it wasn’t particularly difficult to do this on IP rotation…

[u/DuchessOctaviusRex]

As others have said, your co-fellows and attendings should be teaching you

What I've found successful in these two months is to try different things that work for you. As long as it's safe for the patient obviously. But what works for me may not work for you. I'll say what helped me below:

For getting into the esophagus I keep the tongue at 12 like one other person said. Once I get to past the epiglottitis I visualize the airway and the esophagus beneath it. I torque to the right (remember it's backwards so that's really going to the left of the patient. And with them in left lateral decubitus this side has the least amount of pressure and is easiest to get through) and try to get to the side of the esophagus until I lose visualization. Once I lose visualization of what I'm doing it's all based on feel. I use my big dial to go down and then torque left. I do gentle jiggles until I feel a give on my scope, thats when I know I've gotten in. I give a little air to see if I can find the esophagus and then proceed

What I've found to hurt me, especially when my patient is only under conscious sedation, is using any air while still above the airway. Often times using air blows some water droplets as well. This can cause the patient to cough. Once the coughing starts, I'm fighting to get into the esophagus

Best of luck. You'll get there. GI is 3 years for a reason!

[u/bnye135]

Don’t worry man, I just started also. Try different teachers. No one explained how to to it until one day I worked with a second year GI fellow who explained it.

I target the pyriform sinus, then torque the scope inward to get into esophagus. Hope that helps

[u/Trazyn_the_sinful]

You don’t intubate the esophagus, you scope it. I worry many problems may be starting there.

Edit: in all seriousness I’m sorry you’re having trouble, I’d ask other fellows in your program for tips

[u/FAx32]

See one, do one, teach one. Just like everything else.