GEL IMMERSION ENDOSCOPY: INNOVATION IN SECURING THE VISUAL FIELD. CLINICAL EXPERIENCE OF 265 CONSECUTIVE CASES

Aims:

During endoscopy, especially in patients with gastrointestinal bleeding, it is often difficult to secure the visual field using water, because the injected water is rapidly mixed with fresh blood or stool. Clear gel with an appropriate viscosity to prevent rapid mixing is injected through the accessory channel, instead of water. In the space occupied by the clear gel, it is easy to secure the visual field. We reported this method as “gel immersion endoscopy”. The safety and efficacy of this method were evaluated.

Methods:

From June 2012 until December 2017, 265 consecutive procedures were identified by searching the medical records. These records were retrospectively evaluated. After independent evaluation by 3 gastroenterologists, success in securing the visual field and occurrence of adverse events were judged.

Results:

Of 265 total procedures, the visual field was secured/not secured/undecided in 233/21/11, which included 11/2/0 of 13 in the esophagus, 35/5/4 of 44 in the stomach, 37/5/1 in the duodenum, 23/1/3 procedures in the jejunum, 10/0/0 procedures in the ileum, 106/7/2 procedures in the large intestine, 10/1/1 procedures in an afferent limb, and 1/0/0 procedures in the bile duct. Gel immersion endoscopy allowed the identification of bleeding lesions covered by clots, food debris and stool and achieving hemostasis. Of 265 procedures, adverse events occurred in four, including two with post-procedure abdominal pain, one with weight gain in a patient with chronic renal failure and one extension of mediastinitis in a patient with hematemesis due to spontaneous esophageal rupture which occurred before the procedure.

Conclusions:

Gel immersion endoscopy is safe and effective for securing the visual field in many locations in the gastrointestinal tract.