Julio Alejandro Murra-Saca MD.
Tel : (503) 2226-3131, (503) 2225-3087, Celular (503) 7887-2507

Edificio Centro Scan, Colonia Médica, San Salvador, El Salvador.


The Endoscopy has two fields the diagnostic and the Therapeutic.
The Gastroenterology with the therapeutical endoscopy, it is the border between The Surgery and the Internal Medicine.
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Notes on Cyber Gastroenterology

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 Dr. Julio Alejandro Murra Saca  San Salvador. Hiatus hernia that was overcoming with flexible endoscopic suturing. Gastric Leiomyoma  Familiar polyposis  of the colon. Gastric Folders. Rectal Cancer..    
Endoscopy. Radial Endosonography. Radial Endosonography. Ulcerated Gastric Carcinoma. Gastroesophagic junction. Endoscopic Gastroplicature.    

Video Endoscopy of the Upper Gastrointestinal Tract is a modern medical technology that enables us to visualize the inner linings of esophagus, stomach and duodenum. This technology has been greatly improved with the development of Computerized Video-Endoscopy systems which makes high resolution visualization and imaging of the GI tract possible. These images may be captured and stored on VHS, Betacam or U-Matic Tape or on Optical Disk or DVD.
For the procedure you will swallow a thin, flexible, lighted tube with a tiny video camera called an endoscope. Right before the procedure the Gastroenterologist will spray your throat with a numbing agent that may help prevent gagging. You may also receive pain medicine and a sedative to help you relax during the exam. The endoscope transmits an images and videos of the inside of the esophagus, stomach, and duodenum, so the Gastroenterologist can carefully examine the lining of these organs. The scope also blows air into the stomach; this expands the folds of tissue and makes it easier for the physician to examine the stomach
Upper Endoscopy (called "EGD") is an inspection of your esophagus and stomach using a camera on a lengthy tube that is placed down your throat. It allows doctors to find ulcers, cancers in your upper digestive tract and is useful for explaining bleeding, swallowing problems, or abdominal pain.

Frequently Asked Questions about the Endoscopy Procedure

Will I be asleep?

The sedation used for Colonoscopy and Endoscopy is called "Conscious Sedation".   You will be awake and able to talk and move although you may not remember doing so afterwards.

What medications will I receive?

You will receive two medications prior to and during the procedure.

How long does the procedure take?

Colonoscopy can take from 30-60 minutes.

Endoscopy can take from 15-30 minutes.

The procedure can take more or less time and varies from person to person.

How long do I have to stay after my procedure is completed?

On average, patients are observed for 30-60 minutes (this can take longer depending on how well the patient is recovering) after their procedure.   After you have had something to drink, have been able to sit up, have stable vital signs, and are able to ambulate unassisted, you and your companion will be free to leave. (You cannot leave without an adult to escort you home).

When/What can I eat afterwards?

You can eat and drink normally afterwards, although we recommend starting with a light meal and advancing your diet as tolerated.  






Gastrointestinal unit, is observed several monitors and some storage equipment like VCR and image and video processing computer

Please click  on the image to download the video clip.                   Para mayores detalles endoscopicos se debe observar el video presionando sobre la imagen endoscopica
Picture of Endoscopy, the gastric body is observed. Another picture of gastric body is appreciated.

Click on the image to download the video clip. To best appreciate the video, it is recommended to first set up your media player in REPEAT and when the video is displayed press ALT + ENTER to see it in full screen.
:The objectives of this examination: to examine the organs already mentioned mainly to detect gastric cancer in early stage when still hope to be cure see Gastric Cancer. Another objective is to value an abdominal pain and as a preventive medical screening to all person after the forty years. Since cancer almost never it warns in his beginnings . Another fundamental objective is the evaluation of a bleeding , vomits of sanguineous content or black color since we counted on the therapeutic Endoscopy with which we can stop a Bleeding injecting by means of these equipment to the gastric varices of the esophagus or and bleeding a gastric or duodenal ulcer, by means of the biopsy channel a long special steel sounding is introduced which in its internal end takes a needle and by outside a syringe is connected (injector of varices) using a special substance, with this method we stop the hemorrhages of the digestive apparatus superior thus saving a human life, and of a surgery of emergency. The biopsy is the takings of samples of small fragments which are sent to the pathologist their microscopic examination to determine the nature of an injury at histologic and cellular level thus determining if an injury is benign or malign. Also within the therapeutic endoscopy, we eliminated some tumors as they are polyps polypectomy.

Video Endoscopy with Magnifying. Duodenum the Intestinal microvillis are observed.

For more endoscopic details please download the video clip clicking on the image
Photography of video endoscopy of hi-res is appraised the Gastric body.
Click on the image to download the video clip. To best appreciate the video, it is recommended to first set up your media player in REPEAT and when the video is displayed press ALT + ENTER to see it in full screen.

Argon Plasma Coagulator equipment.

We use this equipment for several purposes on therapeutics endoscopy.
Our Endoscopic Reporter.
The patient or the referring physician get the video of the complete endoscopic procedure, in DVD Format.
In our endoscopic unit we have different kinds of endoscopes one of them is a special endoscope with double channel for therapeutical porposes.

The Gastroenterologist can also insert instruments into the scope to remove samples of tissue (biopsy) for further tests.
Gastric Body that has been aprecited with the newest video endoscopes, The IMAGENES ARE EXTREMELY CLEAR And
In this endoscopic sequence are preciated the diferent resolution between
The Zoom 1X.
Zoom enhance level 5. Zoom enhance level 8.
Another view of the gastric folders. Video Endoscopy with magnifying 150x. Duodenum the Intestinal microvillis are observed.

Más detalles descargar el video presionando sobre la imagen endoscópica.
Endoscopic image of the gastric body
Radial Endosonography
Endoscopic ultrasonography (EUS) is a combination of endoscopy and ultrasonography, a small ultrasonic transducer being incorporated into the tip of an endoscope. The high ultrasonic frequencies used ( 7.5 - 20.0 Mhz) provide excellent resolution, distinguishing between structures and lesions as small as 2 - 3 mm .
Gastric Carcinoma.

As with esophageal cancer, EUS can also provide an accurate assessment of the T-stage and, to a somewhat lesser degree, of the N-stage. EUS has also been shown to be superior to CT in the local staging of gastric carcinoma. Assessment of resectability is possible with high reliability. The same problems are encountered as with high reliability. The same problems are encountered as with esophageal cancer, such as overstaging (which mainly occurs in ulcerated carcinomas), identification of malignant lymph-nodes, detection of anastomotic recurrence, and restaging. Since in the histopathological TNM classification, stages T2 and T3 are defined as infiltration into the subserosa (T2) or serosa (T3, this degree of accurate distinction cannot be made by means of EUS, and the EUS results in stage T2 are therefore poorer compared to the EUS results for the more advanced stages. EUS also seems to have difficulties in reliably differentiating between the mucosal and submucosal forms of early gastric cancer, although this distinction would be essential to select patients for endoscopic resection. Il could be that higher frequencies are more accurate in this respect. When surgery is performed in every patient without distant metastases, EUS does not play a major role. However, when pre-treatment protocols are applied, using neoadjuvant chemotherapy in more advanced stages, EUS staging is crucial to select patients for either pre-treatment or primary surgery.
Recommendations : EUS can be used in the preoperative staging of gastric cancer in patients without distant metastases if the local tage has an impact on therapy ( local resection, neoadjuvant chemotherapy
EUS can be used for the preoperative staging and assessment of resectability in operable patients without distant metastases, especially when stage-dependent treatment protocols are applied. The role of EUS in the detection of anastomotic recurrence and in restaging after radiochemotherapy is still under evaluation.
Endoscopic ultrasound has evolved into a useful technology for clinical gastroenterologists. Four applications have reached a point of particular clinical value in the evaluation of patients with cancer, primarily by enhancing our ability to stage patients.
Staging Gastrointestinal Cancer

Because most gastrointestinal cancers begin in the mucosal layer and invade more deeply as they progress, EUS has become a powerful clinical tool for gastrointestinal cancer staging. The ability of EUS to image lymph nodes adjacent to the gastrointestinal tract is also a key element in staging using the TNM staging system. In this classification, T refers to the depth of invasion, N to regional lymph node metastases, and M to distant metastases. EUS, using high-frequency ultrasound, is limited in identifying distant metastases, but has added new accuracy in the staging of depth of penetration and regional lymph nodes.

Más detalles descargar el video presionando sobre la imagen endoscópica.
Radial Endosonography image and video of the gastric body.
Endoscopic Surgery of the upper digestive tract
The Gastroenterology with the therapeutical endoscopy it is the border between The surgery and the internal medicine.
Therapeutic Endoscopy has made possible to remove the gallstones from the bile duct without having a scratch on the abdomen. Various therapeutic procedures such as sclerotherapy or banding of oesophageal varices, bleeding ulcers, dilatation of oesophageal strictures, balloon dilation of achalasia cardia, stenting of biliary, gastrointestinal pancreatic ductal stenosis, polypectomy, foreign body removal and various other procedures can be performed with endoscopy. Endoscopic treatment is much simpler as compared to surgery.
1. The Endoscopic Suturing
Transoral, flexible endoscopic suturing for treatment of GERD
Now we have this new emerging tecnology Endoscopic suturing aims to tighten the valve at the top of the stomach and reduce acid reflux. It does not aim to reduce acid production by the stomach. The attraction of the procedure is that chronic prescription acid-controlling medication therapy is quite expensive and the hope is that a single, miminally invasive procedure might provide similar symptom relief at decreased long-term cost.

The endoscopic suturing device .
For more details download the video clip by clicking on the image.

Hernia del hiato de tamaño grande.Se observa la sutura endoscópica.Se observa la unión de los tejidos por la sutura endoscópica.
51 year-old male with hiatos hernia and heartburn since 3 years ago . This image displays the endoscopic stitches which has tied the gastroesophageal tisues.
It places stitches in two locations near the LES, which are then tied to tighten the valve and increase pressure. There is no incision and no need for general anesthesia.

Another image. Patient relief his GEAR inmediatly.
Cardias incompetente. Cardias incompetente Pinzas flexible de la sutura endoscópica. Sucionando la mucosa con la pinza de sutura endoscópica.  
24 year old, female suffering gerd since 7 years previously due to les incompetence . Another image of gastroesofagic junction. The ESD Flexible Endoscopic Suturing device. It uses the same principal of tightening the junction between the esophagus and the stomach by the placement of sutures. The image and the video display
the step of sucking enough tissue
(mucosa, sub mucosa and
The needle is then fired into the sucked tissue.
We applied the first suture with the first needle and at the same time we removed the valve of
suction and in this way it free the
tissue from the pincer and we
prepared the field for the second
suture which is one centimeter
away from the first one.
Se observan los hilos  de la sutura endoscópica. se observa la unión de dichos tejidos proporcionando una buena resistencia al reflujo del ácido. Se observa la unión de tejidos por medio de la sutura endoscópica  flexible. Otra imagen de dichao procedimiento.
Both threads that have been placed in two stiches forms a single union.
This image displays the endoscopic
Another image of the endoscopic gastroplicature.
Patient relief the GERD.
She did not any anti reflux
pharmacological treatment
any more.

To observe multiple images and video clips of Endoscopy see our on-line atlas.
El Salvador Atlas of Gastrointestinal Video Endoscopy.
Where you can find more than 2500 video clips of hi-res of our experience with the most varied subjects of the gastrointestinal pathology.


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