Transduodenal endoscopy.

The technique to be described is presented as a useful addition to the repertoire of the surgeon who finds nothing abnormal in an abdomen during an operation for haematemesis (case 3), and also where at laparotomy an expected lesion of the stomach is not found, and a full examination of the mucosa is desired (case 10). The approach was prompted by the easy and atraumatic fashion in which the second part of the duodenum can be brought level with the anterior abdominal wall during the first stage of the operation of pancreato-duodenal resection. Incidentally it is emphasized that the successful execution of this step supplies the key to a uniformly satisfactory examination. Although originally planned to allow complete visualization and biopsy of the stomach alone, the technique also provides an approach for inspection and biopsy of the lower oesophagus, the whole of the duodenum, including the papilla of Vater, and a variable amount of the jejunum.