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CC BY 4.0 · Endoscopy 2023; 55(S 01): E1248-E1249
DOI: 10.1055/a-2215-1100
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Use of disposable endoscope for variceal sclerotherapy

Kisako Fujiwara 
1   Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
,
Takayuki Kondo
2   Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
,
Kentaro Fujimoto
1   Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
,
Mai Fujie
3   Department of Clinical Engineering Center, Chiba University Hospital, Chiba, Japan (Ringgold ID: RIN92154)
,
Naoya Kanogawa
2   Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
,
Sadahisa Ogasawara
1   Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
,
Naoya Kato
1   Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
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Diagnostic esophagogastric endoscopy has recently been performed using new sterile single-use disposable endoscopes (Ambu aScope Gastro; Ambu, Ballerup, Denmark) ([Fig. 1]) due to the potential risk of cross-infection associated with reusable endoscopes [1] [2].

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Fig. 1 Ambu aScope Gastro.

N-butyl cyanoacrylate (NBCA) is used for emergency endoscopic hemostasis in cases of gastric and ectopic varices [3] [4]. However, one of the complications associated with the use of NBCA during sclerotherapy is its adhesion to the endoscope, which causes critical damage to the endoscope and incurs high repair costs. In addition, the puncture site can overlap with the endoscope on the fluoroscopic images during sclerotherapy.

We report two cases in which sclerotherapy was performed using the Ambu aScope Gastro for treating gastric and jejunal varices ([Video 1]).


Quality:
Gastric and jejunal variceal sclerotherapy using the Ambu aScope Gastro.Video 1

Case 1 is of a 65-year-old man who was referred for the treatment of gastric varices due to alcoholic cirrhosis. The gastric varices were punctured using a 23-G esophageal varices puncture needle (Sumitomo Bakelite., Tokyo, Japan) ([Fig. 2]). Under fluoroscopic guidance, 1.6 mL of 75% NBCA (NBCA:lipiodol ratio 3:1) was injected. A small quantity of NBCA adhered to the endoscope after the procedure.

Zoom Image
Fig. 2 Use of Ambu aScope Gastro for gastric variceal sclerotherapy. a Gastric varices. b Varices were punctured with a 23-G needle. c N-butyl cyanoacrylate (NBCA) administration. d,e Radiolucent tip of the endoscope allows easier evaluation of contrast flow (arrow: endoscope). f Adherence of NBCA to the scope.

Case 2 is of a 76-year-old man ([Fig. 3]) who was referred by a surgeon following pancreaticoduodenectomy for an intraductal papillary mucinous adenoma because of suspected bleeding from jejunal varices formed at the site of choledochojejunostomy. The jejunal varices were punctured using a 23-G esophageal varices puncture needle. Under fluoroscopic guidance, 2 mL of mixture of 60% NBCA (NBCA:lipiodol ratio 3:2) was injected. The transparency of the soft tissue scope enabled easy confirmation of the flow and polymerization of the sclerosing agent on fluoroscopic images.

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Fig. 3 Use of Ambu aScope Gastro for jejunal variceal sclerotherapy. a Jejunal varices formed at the site of choledochojejunostomy (arrow). A biliary stent was implanted for biliary strictures (arrowhead). b Jejunal varices were punctured with a 23 G needle. c,d Radiolucent tip of the endoscope allows easier evaluation of contrast flow (arrow, endoscope).

These cases demonstrate the successful use of sclerotherapy with NBCA using the Ambu aScope Gastro. This single-use disposable endoscope prevents the need for costly endoscope repair following NBCA adhesion and provides excellent visibility on fluoroscopic images.

Endoscopy_UCTN_Code_TTT_1AO_2AD

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Conflict of Interest

The manufacturer of Ambu aScope Gastro, Ambu K.K., provided the endoscope free of cost.

  • References

  • 1 Ribeiro MM, de Oliveira AC. Analysis of the air/water channels of gastrointestinal endoscopies as a risk factor for the transmission of microorganisms among patients. Am J Infect Control 2012; 40: 913-916
    CrossrefPubMedSearch in Google Scholar
  • 2 Lagström R, Stigaard T, Knuhtsen S. et al. Diagnostic esophagogastroduodenoscopy performed using a novel sterile single-use disposable endoscope. Endoscopy 2022; 54: E1034-E1035
    Thieme ConnectPubMedSearch in Google Scholar
  • 3 Castellanos ER, Seron P, Gisbert JP. et al. Endoscopic injection of cyanoacrylate glue versus other endoscopic procedures for acute bleeding gastric varices in people with portal hypertension. Cochrane Database Syst Rev 2015; 5: CD010180
    PubMedSearch in Google Scholar
  • 4 Garcia-Tsao G, Abraldes JG, Berzigotti A. et al. Portal hypertensive bleeding in cirrhosis: risk stratification, diagnosis, and management: 2016 practice guidance by the American Association for the Study of Liver Diseases. Hepatology 2017; 65: 310-335
    CrossrefPubMedSearch in Google Scholar

Correspondence

Takayuki Kondo, MD, PhD
Department of Gastroenterology, Graduate School of Medicine, Chiba University
Inohana 1-8-1
260-8670 Chiba
Japan   

Publication History

Article published online:
15 December 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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Rüdigerstraße 14, 70469 Stuttgart, Germany

  • References

  • 1 Ribeiro MM, de Oliveira AC. Analysis of the air/water channels of gastrointestinal endoscopies as a risk factor for the transmission of microorganisms among patients. Am J Infect Control 2012; 40: 913-916
    CrossrefPubMedSearch in Google Scholar
  • 2 Lagström R, Stigaard T, Knuhtsen S. et al. Diagnostic esophagogastroduodenoscopy performed using a novel sterile single-use disposable endoscope. Endoscopy 2022; 54: E1034-E1035
    Thieme ConnectPubMedSearch in Google Scholar
  • 3 Castellanos ER, Seron P, Gisbert JP. et al. Endoscopic injection of cyanoacrylate glue versus other endoscopic procedures for acute bleeding gastric varices in people with portal hypertension. Cochrane Database Syst Rev 2015; 5: CD010180
    PubMedSearch in Google Scholar
  • 4 Garcia-Tsao G, Abraldes JG, Berzigotti A. et al. Portal hypertensive bleeding in cirrhosis: risk stratification, diagnosis, and management: 2016 practice guidance by the American Association for the Study of Liver Diseases. Hepatology 2017; 65: 310-335
    CrossrefPubMedSearch in Google Scholar

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Zoom Image
Fig. 1 Ambu aScope Gastro.
Zoom Image
Fig. 2 Use of Ambu aScope Gastro for gastric variceal sclerotherapy. a Gastric varices. b Varices were punctured with a 23-G needle. c N-butyl cyanoacrylate (NBCA) administration. d,e Radiolucent tip of the endoscope allows easier evaluation of contrast flow (arrow: endoscope). f Adherence of NBCA to the scope.
Zoom Image
Fig. 3 Use of Ambu aScope Gastro for jejunal variceal sclerotherapy. a Jejunal varices formed at the site of choledochojejunostomy (arrow). A biliary stent was implanted for biliary strictures (arrowhead). b Jejunal varices were punctured with a 23 G needle. c,d Radiolucent tip of the endoscope allows easier evaluation of contrast flow (arrow, endoscope).