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.
