Endoscopy 2021; 53(04): E130-E131
DOI: 10.1055/a-1216-0216
E-Videos

Novel method using small-caliber endoscope and balloon overtube for removing gastrointestinal residue

Kazuhiro Kozuka
Department of Gastroenterology and Neurology Faculty of Medicine, Kagawa University, Miki, Kita, Kagawa, Japan
,
Hideki Kobara
Department of Gastroenterology and Neurology Faculty of Medicine, Kagawa University, Miki, Kita, Kagawa, Japan
,
Noriko Nishiyama
Department of Gastroenterology and Neurology Faculty of Medicine, Kagawa University, Miki, Kita, Kagawa, Japan
,
Taiga Chiyo
Department of Gastroenterology and Neurology Faculty of Medicine, Kagawa University, Miki, Kita, Kagawa, Japan
,
Nobuya Kobayashi
Department of Gastroenterology and Neurology Faculty of Medicine, Kagawa University, Miki, Kita, Kagawa, Japan
,
Tatsuo Yachida
Department of Gastroenterology and Neurology Faculty of Medicine, Kagawa University, Miki, Kita, Kagawa, Japan
,
Tsutomu Masaki
Department of Gastroenterology and Neurology Faculty of Medicine, Kagawa University, Miki, Kita, Kagawa, Japan
› Author Affiliations

The presence of gastrointestinal blood clots and food residue often makes emergent endoscopic procedures difficult [1] [2]. Removal procedures are conventionally performed using grasping forceps, but these techniques require long procedure times and leave behind large amounts of residue. Although a tube-assisted suction method has been recently reported [3], the ability to pass through a narrow space and the adequacy of suction with side-scope navigation seem limited due to poor followability. For this reason, we developed a novel method of gastrointestinal residue removal using existing instruments.

We conducted an experimental study on two beagle dogs with food jelly filling the upper and middle stomach ([Video 1]). The equipment used consisted of a balloon overtube (TS-12140; Fujifilm, Tokyo, Japan) and a small-caliber endoscope (EG-L580NM7; Fujifilm) ([Fig. 1]). First, a 10 × 10-mm cross-shaped incision was made at the base of the overtube ([Fig. 2]), and the endoscope was fixed 2 mm from the distal tip of the overtube through the incision hole and connected at four points using silk thread ([Fig. 3]). The maximum diameter of the suction channel was 4.9 mm, which is larger than the 3.2-mm forceps channel in a conventional endoscope. Next, the overtube was inserted into the stomach under visual observation via the endoscope. With this configuration, large amounts of residue were effectively aspirated through the channel ([Fig. 4]). Suctioning the superficial mucosa, which is unavoidable unless preventive measures are taken, interrupts the smooth suctioning procedure. We therefore found it useful to push the mucosa using a biopsy forceps to maintain a clear view throughout the procedure ([Fig. 5]). This procedure was successful in creating a clear operation field without any complications in both animals. The procedure time was 6 min on average.

Video 1 Suction equipment and procedure for the proposed novel, rapid, and safe method of removing upper gastrointestinal residue.


Quality:
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Fig. 1 The suction equipment used for this procedure, which includes a nasal endoscope and overtube.
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Fig. 2 Detailed schematic of the equipment, including the suction channel with a 4.9-mm maximum diameter. The endoscope was inserted through the 10 × 10-mm cross-shaped incision at the base of the overtube.
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Fig. 3 The endoscope was fixed 2 mm from the distal tip of the overtube and connected to the overtube at four points using silk thread.
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Fig. 4 Endoscopic images showing the operation field before and after the suction method was applied: a before, b after.
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Fig. 5 Pushing the mucosa using a biopsy forceps was useful to maintain a continuously clear view.

This experiment demonstrates that this novel method may be efficient for removing upper gastrointestinal residue.

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Publication History

Publication Date:
05 August 2020 (online)

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