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Fung BM, Chen FC, Tabibian JH. Clear cap-assisted luminal stenting may improve technical success in gastroduodenal and colonic obstruction. Endosc Int Open 2020; 8:E1429-E1434. [PMID: 33015347 PMCID: PMC7508645 DOI: 10.1055/a-1229-4000] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 05/11/2020] [Indexed: 11/17/2022] Open
Abstract
Background Luminal stenting is safe, effective, and at times the preferred method for relieving gastrointestinal obstruction. However, stent placement is not technically feasible when lesions cannot be traversed with a guidewire, resulting in the need for more invasive methods of palliation and urgent/emergent surgical intervention. In this series, we report our experience with cap-assisted stenting to improve lumen visualization in obstructed segments of the gastrointestinal tract and salvage cases that may have otherwise resulted in technical failure. Methods A clear cap (i. e. distal attachment) was affixed to the scope tip to facilitate visualization and stenting in two cases of gastroduodenal obstruction and three cases of colonic obstruction. Indications for stent placement included malignant obstruction, diverticulitis-associated obstruction, and Crohn's disease-associated stricture. Results In this report, we demonstrate that use of a clear cap facilitated endoscopic stenting in challenging cases of malignant and benign gastroduodenal and colonic obstruction. Conclusions A clear cap for endoscopic stenting can be used in cases in which standard techniques are unsuccessful or those anticipated to be technically difficult at the outset. Cases with tortuous anatomy or particularly tight, friable, or exophytic obstructive lesions may benefit most from this novel technical modification.
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Affiliation(s)
- Brian M. Fung
- Department of Medicine, Olive View-UCLA Medical Center, Sylmar, California, United States
| | - Formosa C. Chen
- Department of Surgery, Olive View-UCLA Medical Center, Sylmar, California, United States
| | - James H. Tabibian
- Division of Gastroenterology, Department of Medicine, Olive View-UCLA Medical Center, Sylmar, California, United States,David Geffen School of Medicine at UCLA, Los Angeles, California, United States
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Thayalasekaran S, Alkandari A, Varytimiadis L, Subramaniam S, Coda S, Longcroft-Wheaton G, Bhandari P. To cap/cuff or ring: do distal attachment devices improve the adenoma detection? Expert Rev Gastroenterol Hepatol 2019; 13:119-127. [PMID: 30791785 DOI: 10.1080/17474124.2019.1551131] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Colonoscopy reduces the risk of colorectal cancer, by interrupting the adenoma-carcinoma sequence enabling the detection and removal of adenomas before they turn into colorectal cancer. Colonoscopy has its limitations as adenoma miss rates as high as 25% have been reported. The reasons for missed pathology are complicated and multi-factorial. The recent drive to improve adenoma detection rates has led to a plethora of new technologies. Areas covered: An increasing number of advanced endoscopes and distal attachment devices have appeared in the market. Advanced endoscopes aim to improve mucosal visualization by widening the field of view. Distal attachment devices aim to increase adenoma detection behind folds by flattening folds on withdrawal. In this review article, we discuss the three following distal attachment devices: the transparent cap, the Endocuff, and the Endoring. Expert commentary: The authors believe that the distal attachment devices will have a greater benefit for endoscopists with low baseline adenoma detection rates.
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Affiliation(s)
| | - Asma Alkandari
- a Gastroenterology Queen Alexandra Hospital , Portsmouth , United Kingdom
| | | | | | - Sergio Coda
- a Gastroenterology Queen Alexandra Hospital , Portsmouth , United Kingdom.,b InHealth Endoscopy Limited , London , United Kingdom
| | | | - Pradeep Bhandari
- a Gastroenterology Queen Alexandra Hospital , Portsmouth , United Kingdom.,c Pharmacy and Biomedical Sciences , University of Portsmouth , Portsmouth , United Kingdom
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Rana SS, Mahajan S. Endoscopic removal of obstructing food bolus: Can a cap do the trick? Gastrointest Endosc 2018; 87:1204-1206. [PMID: 29655435 DOI: 10.1016/j.gie.2018.01.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Accepted: 01/24/2018] [Indexed: 02/08/2023]
Affiliation(s)
- Surinder S Rana
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sarakshi Mahajan
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Ko WJ, Song GW, Hong SP, Kwon CI, Hahm KB, Cho JY. Novel 3D-printing technique for caps to enable tailored therapeutic endoscopy. Dig Endosc 2016; 28:131-8. [PMID: 26347022 DOI: 10.1111/den.12546] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 08/19/2015] [Accepted: 08/31/2015] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIM To evaluate the feasibility of a tailored endoscopic cap created using 3D-printing technology that is customized according to esophagogastric lesions of each patient. METHODS Tailored endoscopic caps, which were designed and fabricated with a 3D printer, were inserted in 35 patients. The types of cap were side-hole cap made for cap-assisted endoscopic mucosal resection (EMRC), oblique-head cap designed for endoscopic submucosal dissection (ESD), wide-head cap used for Trucut biopsy (TCB), and narrow-tip cap to facilitate peroral endoscopic myotomy (POEM). RESULTS EMRC in the esophagus and gastroesophageal junction was carried out using a side-hole cap in seven patients. Median total procedure time for successful removal of lesions was 14 min (range 8-50 min). Gastric ESD was carried out using with an oblique-head cap in 16 patients, for which the median total procedure time was 53 min. TCB in the esophagus was done using a wide-head cap in eight patients. While carrying out POEM for tunneling, a narrow-tip cap was used in four patients with achalasia. CONCLUSION Based on the current proof-of-concept study, we anticipate that creating a tailored endoscopic cap is feasible for therapeutic endoscopy.
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Affiliation(s)
- Weon Jin Ko
- Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Ga Won Song
- Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Sung Pyo Hong
- Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Chang-il Kwon
- Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Ki Baik Hahm
- Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Joo Young Cho
- Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam, Korea
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Muguruma N, Kitamura S, Kimura T, Miyamoto H, Takayama T. Endoscopic management of nonvariceal upper gastrointestinal bleeding: state of the art. Clin Endosc 2015; 48:96-101. [PMID: 25844335 PMCID: PMC4381152 DOI: 10.5946/ce.2015.48.2.96] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 01/17/2015] [Indexed: 12/16/2022] Open
Abstract
Nonvariceal upper gastrointestinal (GI) bleeding is one of the most common reasons for hospitalization and a major cause of morbidity and mortality worldwide. Recently developed endoscopic devices and supporting apparatuses can achieve endoscopic hemostasis with greater safety and efficiency. With these advancements in technology and technique, gastroenterologists should have no concerns regarding the management of acute upper GI bleeding, provided that they are well prepared and trained. However, when endoscopic hemostasis fails, endoscopy should not be continued. Rather, endoscopists should refer patients to radiologists and surgeons without any delay for evaluation regarding the appropriateness of emergency interventional radiology or surgery.
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Affiliation(s)
- Naoki Muguruma
- Department of Gastroenterology and Oncology, Institute of Health Biosciences, The University of Tokushima Graduate School, Tokushima, Japan
| | - Shinji Kitamura
- Department of Gastroenterology and Oncology, Institute of Health Biosciences, The University of Tokushima Graduate School, Tokushima, Japan
| | - Tetsuo Kimura
- Department of Gastroenterology and Oncology, Institute of Health Biosciences, The University of Tokushima Graduate School, Tokushima, Japan
| | - Hiroshi Miyamoto
- Department of Gastroenterology and Oncology, Institute of Health Biosciences, The University of Tokushima Graduate School, Tokushima, Japan
| | - Tetsuji Takayama
- Department of Gastroenterology and Oncology, Institute of Health Biosciences, The University of Tokushima Graduate School, Tokushima, Japan
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Management of ingested foreign bodies in children: a clinical report of the NASPGHAN Endoscopy Committee. J Pediatr Gastroenterol Nutr 2015; 60:562-74. [PMID: 25611037 DOI: 10.1097/mpg.0000000000000729] [Citation(s) in RCA: 314] [Impact Index Per Article: 34.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Foreign body ingestions in children are some of the most challenging clinical scenarios facing pediatric gastroenterologists. Determining the indications and timing for intervention requires assessment of patient size, type of object ingested, location, clinical symptoms, time since ingestion, and myriad other factors. Often the easiest and least anxiety-producing decision is the one to proceed to endoscopic removal, instead of observation alone. Because of variability in pediatric patient size, there are less firm guidelines available to determine which type of object will safely pass, as opposed to the clearer guidelines in the adult population. In addition, the imprecise nature of the histories often leaves the clinician to question the timing and nature of the ingestion. Furthermore, changes in the types of ingestions encountered, specifically button batteries and high-powered magnet ingestions, create an even greater potential for severe morbidity and mortality among children. As a result, clinical guidelines regarding management of these ingestions in children remain varied and sporadic, with little in the way of prospective data to guide their development. An expert panel of pediatric endoscopists was convened and produced the present article that outlines practical clinical approaches to the pediatric patient with a variety of foreign body ingestions. This guideline is intended as an educational tool that may help inform pediatric endoscopists in managing foreign body ingestions in children. Medical decision making, however, remains a complex process requiring integration of clinical data beyond the scope of these guidelines. These guidelines should therefore not be considered to be a rule or to be establishing a legal standard of care. Caregivers may well choose a course of action outside of those represented in these guidelines because of specific patient circumstances. Furthermore, additional clinical studies may be necessary to clarify aspects based on expert opinion instead of published data. Thus, these guidelines may be revised as needed to account for new data, changes in clinical practice, or availability of new technology.
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Kim JS, Park SM, Kim BW. Endoscopic management of peptic ulcer bleeding. Clin Endosc 2015; 48:106-11. [PMID: 25844337 PMCID: PMC4381136 DOI: 10.5946/ce.2015.48.2.106] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 03/06/2015] [Accepted: 03/11/2015] [Indexed: 01/14/2023] Open
Abstract
Acute upper gastrointestinal bleeding is a common medical emergency around the world and the major cause is peptic ulcer bleeding. Endoscopic treatment is fundamental for the management of peptic ulcer bleeding. Despite recent advances in endoscopic treatment, mortality from peptic ulcer bleeding has still remained high. This is because the disease often occurs in elderly patients with frequent comorbidities and are taking ulcerogenic medications. Therefore, the management of peptic ulcer bleeding is still a challenge for clinicians. This article reviews the various endoscopic methods available for management of peptic ulcer bleeding and the techniques in using these methods.
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Affiliation(s)
- Joon Sung Kim
- Division of Gastroenterology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Sung Min Park
- Division of Gastroenterology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Byung-Wook Kim
- Division of Gastroenterology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
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Baron TH. Endoscopic treatment of Zenker diverticulum. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2014. [DOI: 10.1016/j.tgie.2013.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Choi YR, Han JH, Cho YS, Han HS, Chae HB, Park SM, Youn SJ. Efficacy of cap-assisted endoscopy for routine examining the ampulla of Vater. World J Gastroenterol 2013; 19:2037-2043. [PMID: 23599622 PMCID: PMC3623980 DOI: 10.3748/wjg.v19.i13.2037] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Revised: 10/22/2012] [Accepted: 11/06/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To determine the efficacy of a cap-assisted endoscopy (CAE) to completely visualize the ampulla of Vater (AV) in patients failed by conventional endoscopy.
METHODS: A prospective study was conducted on 120 patients > 20 years of ages who visited the Health Promotion Center of Chungbuk National University Hospital for conscious sedation esophagogastroduodenoscopy (EGD) as a screening test from July to October, 2011. First, forward-viewing endoscopy was performed with reasonable effort using a push and pull method. We considered complete visualization of the AV when we could observe the entire AV including the orifice clearly, and reported the observation as complete or incomplete (partial or not found at all). Second, in cases of complete failure of the observation, an additional AV examination was conducted by attaching a short cap (D-201-10704, Olympus Medical Systems, Tokyo, Japan) to the tip of a forward-viewing endoscope. Third, if the second method failed, we replaced the short cap with a long cap (MH-593, Olympus Medical Systems) and performed a re-examination of the AV.
RESULTS: Conventional endoscopy achieved complete visualization of the AV in 97 of the 120 patients (80.8%) but was not achieved in 23 patients (19.2%). Age (mean ± SD) and gender [male (%)] were not significantly different between the complete observation and the incomplete observation groups. Additional short CAE was performed in patients in whom we could not completely visualize the AV. This group included 13 patients (10.9%) with partial observation of the AV and 10 (8.3%) in which the AV was not found. Short CAE permitted a complete observation of the AV in 21 of the 23 patients (91.3%). Patients in whom visualization of the AV failed with short CAE had satisfactory outcomes by replacing the short cap with a long cap. The additional time for CAE took an average of 141 ± 88 s. There were no complications and no significant mucosal trauma.
CONCLUSION: CAE is safe to use as a salvage method to achieve complete visualization of the AV when a regular EGD examination fails.
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Rajan E, Gostout CJ, Lurken MS, Talley NJ, Locke GR, Szarka LA, Sumiyama K, Bakken TA, Stoltz GJ, Knipschield MA, Farrugia G. Endoscopic "no hole" full-thickness biopsy of the stomach to detect myenteric ganglia. Gastrointest Endosc 2008; 68:301-7. [PMID: 18262183 PMCID: PMC2814422 DOI: 10.1016/j.gie.2007.10.017] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2007] [Accepted: 10/02/2007] [Indexed: 02/08/2023]
Abstract
BACKGROUND The etiology of several common gastric motility diseases remains largely unknown. Gastric wall biopsy specimens that include the muscularis propria to evaluate the enteric nervous system, interstitial cells of Cajal, and related cells are essential to promote our understanding of the pathophysiologic mechanisms. On the basis of our previous work, a double EMR technique provided sufficient tissue to identify myenteric ganglia. A serious limitation to the technique was the resultant gastric wall perforation after tissue resection. The optimal procedure would seal the gastric wall defect before tissue resection, eliminating the risk of peritonitis. OBJECTIVES The aims of this study were to (1) determine the technical feasibility and reproducibility of a full-thickness gastric biopsy by use of a novel double EMR technique without creating a perforation ("no hole") and to (2) determine safety of the procedure. DESIGN AND INTERVENTIONS Preclinical study of 6 pigs. Each animal underwent a "no hole" double EMR survival procedure. To prevent perforation, detachable endoloops and prototype T-tag tissue anchors were placed before resection. At 2 weeks repeat endoscopy was performed followed by necropsy. MAIN OUTCOME MEASUREMENTS Hematoxylin-eosin staining was used to determine which muscle layers were included in the resected specimen, and an antibody to neuronal nitric oxide synthase was used to visualize myenteric ganglia in the sample. Technical feasibility, reproducibility, and safety of the procedure were evaluated. RESULTS Full-thickness gastric biopsy specimens were obtained from all animals without overt perforation. There were no procedural complications. Histologic examination showed muscularis propria with all layers of muscle present, and immunochemical studies demonstrated myenteric ganglia in all tissue samples. Four animals had an uneventful clinical course, and repeat endoscopy at week 2 showed ulceration with stellate fibrosis. Necropsy showed mild localized adhesions. Two animals were killed at days 3 and 6, respectively, because of suspected peritonitis. At necropsy, delayed perforations at the resection sites were noted with displaced endoloops and tissue anchors. CONCLUSION This study explored the concept of obtaining deep muscle wall biopsy specimens with use of a unique approach of resection without perforation. The novel "no hole" double EMR technique was technically feasible and reproducible with sufficient tissue obtained to identify myenteric ganglia. However, there was a high delayed perforation rate associated with displaced endoloops and tissue anchors. On the basis of this early experience, improved safety data may be anticipated with future studies using improved tissue closure devices.
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Affiliation(s)
- Elizabeth Rajan
- Division of Gastroenterology and Hepatology, Developmental Endoscopy Unit, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA
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Bunno M, Kawaguchi M, Yamahara K, Kanda C. Removal of a foreign body (artificial tooth) from the bronchial tree: a new method. Intern Med 2008; 47:1695-8. [PMID: 18827418 DOI: 10.2169/internalmedicine.47.1173] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 70-year-old man who had aspirated an artificial tooth during treatment at a dental clinic visited our hospital. His symptoms and physical condition were not remarkable. CT of chest revealed a foreign body in the right middle bronchus; bronchoscopy revealed it was wedged there. First, the authors tried to remove it using a suction device attached to a bronchoscope, as well as by using a forcep; however, the attempt failed. Therefore, a second effort was made using a cap constructed of a nasogastric tube, based on the concept of attaching an endoscopic cap to a bronchoscope. The latter was successful.
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Affiliation(s)
- Maki Bunno
- Gastroenterology, Saiseikai Wakayama Hospital.
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