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DOI: 10.1055/a-2114-0131
A novel method, gel immersion endoscopic injection sclerotherapy, may make the procedure easier and more accurate
Esophageal varices are caused by portal hypertension such as cirrhosis. Ruptured esophageal varices cause massive bleeding; therefore, preventive hemostasis is important. The standard procedures to prevent bleeding include endoscopic variceal ligation (EVL) and endoscopic injection sclerotherapy (EIS). EIS is a more difficult procedure than EVL but results in a lower recurrence rate and is more curative. In particular, problems are often faced in the process of inserting a needle into esophageal varices and injecting sclerosing agents into the vessel. Gel immersion endoscopy is a useful method for securing a visual field [1]. Additionally, a lower level of intraluminal pressure and wall tension is maintained [2] and the vessel lumen is kept thicker and wider than that during gas emersion ([Fig. 1]). Therefore, EIS with a “Viscoclear” gel (Otsuka Pharmaceutical Factory, Tokushima, Japan) may allow easier needle insertion and sclerosing material injection into esophageal varices.
Herein, a 73-year-old man was admitted to a psychiatric hospital for schizophrenia. Upper gastrointestinal endoscopy revealed F2 or larger esophageal varices that required treatment, and he was transferred to our hospital for prophylactic hemostasis ([Video 1]). We performed EIS of the esophageal varices using gel immersion endoscopy. Under the gel, the vessels were thicker due to the lower pressure in the esophageal lumen ([Fig. 2]), and ultrasound endoscopy confirmed that the vascular lumen remained circular ([Fig. 3]). We were able to puncture the vessel under the gel and inject sufficient sclerosing agent. A total of 600 mL of gel was used and the procedure time was 4 min. No irrigation accessories were used. Gel-immersion EIS may be useful as it makes the puncture process easier and more accurate.
Video 1 Gel-immersion endoscopic injection sclerotherapy (EIS) may be useful because it makes the puncture process easier and more accurate.
Quality:
Endoscopy_UCTN_Code_CCL_1AB_2AC_3AG
E-Videos is an open access online section of the journal Endoscopy, reporting on interesting cases and new techniques in gastroenterological endoscopy. All papers include a high-quality video and are published with a Creative Commons CC-BY license. Endoscopy E-Videos qualify for HINARI discounts and waivers and eligibility is automatically checked during the submission process. We grant 100% waivers to articles whose corresponding authors are based in Group A countries and 50% waivers to those who are based in Group B countries as classified by Research4Life (see: https://www.research4life.org/access/eligibility/).
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Publication History
Article published online:
27 July 2023
© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)
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References
- 1 Yano T, Takezawa T, Hashimoto K. et al. Gel immersion endoscopy: innovation in securing the visual field – clinical experience with 265 consecutive procedures. Endosc Int Open 2021; 9: E1123-E1127
- 2 Yano K, Yano T, Nagayama M. et al. Hemostasis of an actively bleeding lesion at the ileocecal valve by low-pressure endoscopy using the gel immersion technique. Video-GIE 2021. VideoGIE 2021; 6: 184-186