Endosc Int Open 2015; 03(05): E400-E404
DOI: 10.1055/s-0034-1392363
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Ultra-thin caliber endoscopes in daily practice: uses for therapeutic application and beyond on the basis of review of 1028 procedures

Leendert H. Oterdoom
Department of Gastroenterology and Hepatology, VU University Medical Center, Amsterdam, the Netherlands
Jorn C. Goet
Department of Gastroenterology and Hepatology, VU University Medical Center, Amsterdam, the Netherlands
Maarten A. J. M. Jacobs
Department of Gastroenterology and Hepatology, VU University Medical Center, Amsterdam, the Netherlands
Chris J. J. Mulder
Department of Gastroenterology and Hepatology, VU University Medical Center, Amsterdam, the Netherlands
› Author Affiliations
Further Information

Publication History

submitted: 08 October 2014

accepted after revision: 04 May 2015

Publication Date:
17 July 2015 (online)

Background and study aims: Ultra-thin caliber endoscopes (UTCEs) are versatile and applicable in various conditions. However, only limited data exist on the actual daily clinical use of UTCEs. The aim of our study was to determine indications for UTCEs in a large patient cohort. In turn, our 2 main objectives were (1) to evaluate patient comfort and safety and (2) to determine benefits and potential advantages associated with the use of UTCEs in this same cohort.

Patients and methods: We performed a retrospective analysis of our prospective database of 1028 procedures with UTCEs in 457 patients. All procedures were carried out in the Department of Gastroenterology and Hepatology, VU University Medical Center, in Amsterdam, the Netherlands, between May 2008 and May 2014. In these procedures, either the Fujinon (Tokyo, Japan) EG-530N UTCE or the Olympus (Tokyo, Japan) GIF N-180 UTCE was used.

Results: Mean (standard deviation [SD]) age of patients was 64 (20) years, and most (60 %) of the patients were men. Most (61 %) of the underlying diseases, requiring endoscopic procedures, were found in the esophagus. Of the procedures performed, 91 % were successful, and 82 % were therapeutic. In comparison with regular endoscopes, the most important advantage of the UTCE was the ability to pass a stenosis (37 %), followed by nasogastric feeding tube placement (13 %). Newer and more innovative uses of the UTCE were percutaneous endoscopic gastrostomy (PEG)-jejunal extension placement with endoscope introduction through existing PEG tract, retrograde esophageal introduction through existing PEG tract, inspection of colonic neovagina stenosis, and direct inspection of the common bile duct.

Conclusions: In everyday clinical practice, the UTCE has specific advantages over conventional endoscopes because of its small caliber. The 3 main advantages are (1) introduction of high-grade strictures; (2) introduction of fistulas, including PEG fistula; and (3) increased patient comfort. The endoscopist should appreciate these advantages and consider use of the UTCE accordingly.

  • References

  • 1 Kim CY, O'Rourke RW, Chang EY et al. Unsedated small-caliber upper endoscopy: an emerging diagnostic and therapeutic technology. Surg Innov 2006; 13: 31-39
  • 2 Jobe BA, Hunter JG, Chang EY et al. Office-based unsedated small-caliber endoscopy is equivalent to conventional sedated endoscopy in screening and surveillance for Barrett's esophagus: a randomized and blinded comparison. Am J Gastroenterol 2006; 101: 2693-2703
  • 3 Osawa H, Yamamoto H, Miura Y et al. Diagnosis of depressed-type early gastric cancer using small-caliber endoscopy with flexible spectral imaging color enhancement. Dig Endosc 2012; 24: 231-236
  • 4 Choe WH, Kim JH, Ko SY et al. Comparison of transnasal small-caliber vs. peroral conventional esophagogastroduodenoscopy for evaluating varices in unsedated cirrhotic patients. Endoscopy 2011; 43: 649-656
  • 5 Mulcahy HE, Fairclough PD. Ultrathin endoscopy in the assessment and treatment of upper and lower gastrointestinal tract strictures. Gastrointest Endosc 1998; 48: 618-620
  • 6 Aydinli M, Koruk I, Dag MS et al. Ultrathin endoscopy for gastrointestinal strictures. Dig Endosc 2012; 24: 150-153
  • 7 Seth AK, Puri P, Chandra A. Role of ultrathin transnasal esophagogastroduodenoscopy: experience with 50 patients. Indian J Gastroenterol 2009; 28: 183-185
  • 8 Cho S, Arya N, Swan K et al. Unsedated transnasal endoscopy: a Canadian experience in daily practice. Can J Gastroenterol 2008; 22: 243-246
  • 9 Urakami Y, Nokihara M, Kishi S et al. The GIF-P2 as a panendoscope. Gastrointest Endosc 1979; 25: 88-91
  • 10 Mogan GR, Gottfried EB, Waye JD. A technique for emergency upper gastrointestinal endoscopy in adults using a small caliber endoscope (GIF-P2). Gastrointest Endosc 1980; 26: 126-127
  • 11 Yuki M, Amano Y, Komazawa Y et al. Unsedated transnasal small-caliber esophagogastroduodenoscopy in elderly and bedridden patients. World J Gastroenterol 2009; 15: 5586-5591
  • 12 Ustundag Y, Saritas U, Ponchon T. Unsedated small caliber esophagogastroduodenoscopy: can we trust this technique?. Turk J Gastroenterol 2011; 22: 237-242
  • 13 Bar-Meir S, Rotmensch S. Investigation of obstructive jaundice by an ultra-thin-caliber endoscope: a new technique for potential use in pregnancy. Am J Obstet Gynecol 1984; 150: 1003-1004
  • 14 Lee YN, Moon JH, Choi HJ et al. Direct peroral cholangioscopy using an ultraslim upper endoscope for management of residual stones after mechanical lithotripsy for retained common bile duct stones. Endoscopy 2012; 44: 819-824
  • 15 Huang SW, Lin CH, Lee MS et al. Residual common bile duct stones on direct peroral cholangioscopy using ultraslim endoscope. World J Gastroenterol 2013; 19: 4966-4972
  • 16 Moriwaki Y, Arata S, Iwashita M et al. A case of cervical esophageal perforation after transnasal gastrointestinal fibroscopy using a small-caliber fiber. Endoscopy 2011; 43: 147-148
  • 17 Walter T, Chesnay AL, Dumortier J et al. Biopsy specimens obtained with small-caliber endoscopes have comparable diagnostic performances than those obtained with conventional endoscopes: a prospective study on 1335 specimens. J Clin Gastroenterol 2010; 44: 12-17