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CC BY 4.0 · Endoscopy 2025; 57(S 01): E1119-E1120
DOI: 10.1055/a-2695-4427
E-Videos

Clinical utility of long cap-assisted suction: two cases of food bolus and intraprocedural clot removal

Authors

  • Nobutaka Doba 

    1   Department of Gastroenterology, Yokosuka City Hospital, Yokosuka, Japan (Ringgold ID: RIN36998)

  • Kosuke Shibayama

    1   Department of Gastroenterology, Yokosuka City Hospital, Yokosuka, Japan (Ringgold ID: RIN36998)

  • Shinzo Abe

    1   Department of Gastroenterology, Yokosuka City Hospital, Yokosuka, Japan (Ringgold ID: RIN36998)

  • Daiki Sakuma

    1   Department of Gastroenterology, Yokosuka City Hospital, Yokosuka, Japan (Ringgold ID: RIN36998)

  • Masanobu Someya

    1   Department of Gastroenterology, Yokosuka City Hospital, Yokosuka, Japan (Ringgold ID: RIN36998)

  • Kazuto Komatsu

    1   Department of Gastroenterology, Yokosuka City Hospital, Yokosuka, Japan (Ringgold ID: RIN36998)

  • Shin Maeda

    2   Department of Gastroenterology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
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Cap-assisted suction techniques have been described for food bolus extraction and foreign body removal [1] [2] [3]. However, video-based documentation of long cap-assisted suction – particularly for piecemeal removal or intraprocedural clot clearance – remains limited ([Fig. 1]). Herein, we present two cases highlighting the versatility of this approach.

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Fig. 1 Left: Normal cap (M-201-11804; outer diameter 12.1 mm; tip protrusion length 4 mm; Olympus, Tokyo, Japan). Right: Long cap (MH-463; outer diameter 13.5 mm; tip protrusion length 12 mm; Olympus).

Case 1: A 93-year-old woman presented with complete esophageal obstruction caused by a large food bolus ([Fig. 2] a). The push technique was not feasible ([Fig. 2] b), and retrieval net attempts failed due to poor visualization and a narrowed lumen. Thus, the cap-assisted suction technique was attempted. First, a long transparent cap and overtube were mounted onto the endoscope ([Fig. 2] c). Portions of the bolus were then suctioned into the cap, and the scope was withdrawn and rinsed ([Video 1]). This cycle was repeated until 141 g of food was removed over 35 minutes under intravenous sedation. No complications occurred during the procedure ([Fig. 2] d).

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Fig. 2 Case 1 images. a Pretreatment computed tomography image showing suspected esophageal food bolus impaction. The area delineated by the red line indicates the food bolus. b Pretreatment endoscopic image showing a large food bolus in the upper thoracic esophagus; endoscope insertion into the distal esophagus was not possible. c Pre-suction endoscopic image: the opening of the long cap positioned at the oral side of the food bolus. d Post-treatment endoscopic image showing the esophagogastric junction after complete removal of the food bolus.

Case 2: A 52-year-old man undergoing gastric endoscopic submucosal dissection (ESD) experienced spurting hemorrhage ([Fig. 3] a, b). After achieving hemostasis, a large volume of clotted blood accumulated. Both the retrieval net and short cap-assisted suction techniques were ineffective, and long cap-assisted suction was subsequently attempted ([Video 1]). The latter technique enabled effective clot removal, allowing safe continuation of ESD ([Fig. 3] c, d).

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Clinical utility of long cap-assisted suction.Video 1

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Fig. 3 Case 2 images. a Endoscopic image before endoscopic submucosal dissection showing early gastric cancer (0–IIc) on the anterior wall of the upper gastric body. b Intraprocedural endoscopic image showing active spurting hemorrhage during mucosal incision. c Pre-suction endoscopic image demonstrating the long cap opening located adjacent to the clot. d Post-suction endoscopic image following clot removal.

Compared with conventional pull-based retrieval or external suction methods [4] [5], long cap-assisted suction offers improved control, soft tissue engagement, and a simplified setup without the need for additional tubing or general anesthesia. It is a simple and reproducible procedure that requires only standard equipment.

This method is particularly advantageous in emergency settings or during therapeutic procedures when time and visibility are critical. It offers a safe, cost-effective solution for difficult bolus or clot removal and may be integrated into routine endoscopy practice.

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Artikel online veröffentlicht:
30. September 2025

© 2025. 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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