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Endoscopic procedures are distinguished from endoscopy procedures. The distinction depends on the Action (qualifier value) of the Method (attribute).

In an endoscopy, the Method is Inspection - action (qualifier value).  For these procedures, Endoscope, device (physical object) is the value for Using device (attribute).

For example, 

• • 427595003 |Capsule endoscopy (procedure)| has the Relationship group
    • Using device = Video capsule endoscopy system capsule (physical object)
    • Procedure site - Direct = Gastrointestinal tract structure (body structure)
    • Method = Inspection - action (qualifier value)

In an endoscopic procedure, the Method (attribute) has some other action. It is accomplished by gaining access to the procedure site via an endoscope. For these procedures Endoscope device (physical object) is the value for Using Access Device (attribute). This specifies that the endoscope is used to access the site. 

For example, 

• • 53767003 |Endoscopic biopsy (procedure)| has the Relationship group
    • Using access device = Endoscope, device (physical object)
    • Method = Biopsy - action (qualifier value)