Endoscopy 2022; 54(08): E466-E467
DOI: 10.1055/a-1625-3639
E-Videos

Miniature-probe endoscopic ultrasonography using a rubber balloon to evaluate gastrointestinal carcinomas in poor underwater conditions

Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kita, Kagawa, Japan
,
Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kita, Kagawa, Japan
,
Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kita, Kagawa, Japan
,
Tingting Shi
Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kita, Kagawa, Japan
,
Taiga Chiyo
Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kita, Kagawa, Japan
,
Tatsuo Yachida
Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kita, Kagawa, Japan
,
Tsutomu Masaki
Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kita, Kagawa, Japan
› Author Affiliations
 

Miniature-probe endoscopic ultrasonography (m-EUS) is routinely used to diagnose the invasion depth of gastrointestinal carcinomas [1] [2]. However, the efficacy of EUS is sometimes limited in locations such as the esophagus and esophagogastric junction, where water does not accumulate sustainably [3] [4]. A rubber balloon (MAJ-213; Olympus, Tokyo, Japan) is clinically available for attaching to a convex-type EUS probe [5]. We describe a novel m-EUS method using this rubber balloon without the need for intraluminal underwater conditions ([Fig. 1]; [Video 1]).

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Fig. 1 a To overcome problems of miniature-probe endoscopic ultrasonography (m-EUS) in locations such as the esophagus and esophagogastric junction, where water does not accumulate sustainably, a rubber balloon was attached to a conventional endoscope and fixed with tape. b The balloon was filled with water using the water jet function, and the miniature probe was inserted within the water-filled balloon.

Video 1 Miniature-probe endoscopic ultrasonography using a rubber balloon to diagnose the invasion depth of a carcinoma located at the esophagogastric junction, where water pooling was poor.


Quality:

A 74-year-old man presented with a 25-mm protruding carcinoma located at the esophagogastric junction ([Fig. 2]). EUS with a high-frequency 20-MHz miniature probe (UM-3R; Olympus) was performed to diagnose the tumor invasion depth. However, conventional m-EUS could not capture an underwater image because the water passed easily into the stomach. It was for this reason that we developed and used our m-EUS system, as follows. First, the rubber balloon was attached to a conventional endoscope (GIF-H260Z; Olympus) and fixed with tape. The endoscope reached the target lesion and provided an acceptable endoscopic view ([Fig. 3]). Now the balloon was filled with water using the water jet function and the miniature probe inserted within the water-filled balloon. m-EUS revealed a well-demarcated hypoechoic mass within the second layer and an intact submucosal layer ([Fig. 4]), and diagnosed the tumor depth as within the mucosa. In accordance with the EUS diagnosis, endoscopic submucosal dissection was completed. Histological examination confirmed curative resection of adenocarcinoma with mucosal invasion.

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Fig. 2 A 25-mm diameter protruding carcinoma located at the esophagogastric junction in a 74-year-old man.
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Fig. 3 Acceptable endoscopic image under the balloon attached to the endoscope.
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Fig. 4 The m-EUS image showed a well-demarcated hypoechoic mass within the second layer and an intact submucosal layer.

This method was also useful in another patient for diagnosing the invasion depth of a signet ring cell carcinoma located in the antrum of the remnant stomach where there was poor water pooling ([Fig. 5]).

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Fig. 5 Signet ring cell carcinoma located in the antrum of the remnant stomach in another patient. The m-EUS image using the balloon also clearly visualized a hypoechoic mass within the mucosal layer.

m-EUS using a rubber balloon is simple and effective for resolving poor underwater visual conditions.

Endoscopy_UCTN_Code_TTT_1AS_2AG

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Competing interests

The authors declare that they have no conflict of interest.


Corresponding author

Nobuya Kobayashi, MD, PhD
Department of Gastroenterology and Neurology
Kagawa University
1750-1 Ikenobe
Miki
Kita
Kagawa 761-0793
Japan   

Publication History

Article published online:
27 September 2021

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Zoom Image
Fig. 1 a To overcome problems of miniature-probe endoscopic ultrasonography (m-EUS) in locations such as the esophagus and esophagogastric junction, where water does not accumulate sustainably, a rubber balloon was attached to a conventional endoscope and fixed with tape. b The balloon was filled with water using the water jet function, and the miniature probe was inserted within the water-filled balloon.
Zoom Image
Fig. 2 A 25-mm diameter protruding carcinoma located at the esophagogastric junction in a 74-year-old man.
Zoom Image
Fig. 3 Acceptable endoscopic image under the balloon attached to the endoscope.
Zoom Image
Fig. 4 The m-EUS image showed a well-demarcated hypoechoic mass within the second layer and an intact submucosal layer.
Zoom Image
Fig. 5 Signet ring cell carcinoma located in the antrum of the remnant stomach in another patient. The m-EUS image using the balloon also clearly visualized a hypoechoic mass within the mucosal layer.