Separation of an overtube from the bite block during band ligation of esophageal varices

Efficacy of an assistive guide tube for improved endoscopic access to gastrointestinal lesions: an in vivo study in a porcine model

BACKGROUND/AIMS

Guide tube-assisted endoscopy for procedures that require repeated endoscopic access is safer and more effective than conventional endoscopy. However, its effectiveness has not been confirmed in animal studies. We assessed the usefulness of guide tube-assisted endoscopic procedures in an in vivo porcine model.

METHODS

Five different guide tube-assisted endoscopic procedures were performed by experienced endoscopists on a pig weighing 32 kg. To evaluate the efficacy of these procedures, we compared the endoscopic approach time when a guide tube was used to that when it was not. Additional endoscopic procedures using a guide tube were performed, including multiple foreign body extractions, multiple polypectomies, and multiple submucosal dissections. To evaluate safety, we compared the insertion force into the proximal esophagus between the guide tube and conventional overtube methods.

RESULTS

Using the endoscopic approach with a guide tube required a shorter average approach time to reach the three target lesions than when using the endoscopic approach without a guide tube (p<0.001). Compared to the conventional overtube method, the guide tube method produced a lower average resistance during insertion into the upper esophagus (p<0.001).

CONCLUSION

Guide tube-assisted endoscopic procedures are effective and safe for repeated endoscopic access in an in vivo porcine model.

Technical Feasibility of a Guidetube for Various Endoscopic Procedures in Human Gastrointestinal Simulators

BACKGROUND/AIMS

Many gastrointestinal (GI) endoscopic procedures are difficult and cumbersome owing to the limitation of currently available endoscopic devices. This study aimed to develop an endoscopic guidetube for multipurpose endoscopic procedures and assess its use in a realistic GI endoscopic simulator.

METHODS

The guidetube used is a soft overtube composed of neoprene and is designed to assist various endoscopic procedures on demand. In total, 15 types of procedures were performed in GI simulators. Four procedures were performed in the stomach model and 11 in the colon model. The procedures include repeated endoscopic insertion and foreign body removal in various positions. The mean insertion and procedure time were assessed in each session. All procedures were performed by 5 expert endoscopists.

RESULTS

Endoscopic procedures with the new guidetube were faster and more effective than the conventional endoscopic techniques. The mean insertion time of the endoscope with the guidetube was significantly shorter than that without the guidetube. The guidetube was safely inserted without scratch using low pushing force. Objects of various sizes larger than the endoscopic channel were easily removed by the guidetube-assisted endoscopic procedures.

CONCLUSION

This preliminary study shows that guidetube-assisted endoscopic procedures are faster, easier, safer and cheaper than conventional endoscopic procedures.

Extraction of hollow gastric foreign bodies by flexible upper endoscopy assisted by a through-the-scope balloon catheter for anchoring

BACKGROUND

Various methods have been used to remove foreign bodies; hollow foreign bodies deserve special consideration. The main difficulty encountered in such situations is the anatomic obstacle of the lower and upper esophageal sphincters along with a risk of perforation.

OBJECTIVE

We describe a unique approach by using an esophageal balloon dilator to anchor a hollow foreign body onto an endoscope, which allows for the successful extraction of such objects with minimal risk.

DESIGN

Case series.

SETTING

Shands Jacksonville and University of Florida/Jacksonville, Jacksonville, Florida.

PATIENTS

Two consecutive patients with hollow foreign bodies in the stomach that required removal.

INTERVENTIONS

A combined approach by using an endoscope and a 20-mm by 8-cm esophageal balloon dilator to remove hollow foreign bodies from the stomach.

MAIN OUTCOME MEASUREMENTS

Nonsurgical removal of hollow gastric foreign bodies.

RESULTS

Both foreign bodies were successfully removed from the stomach and extracted by mouth with this technique. There were no complications after both procedures.

CONCLUSIONS

The inflated esophageal balloon that anchors a hollow foreign body onto a flexible endoscopic technique is a safe and effective alternative to previously described methods for removal of such foreign bodies in the gastric cavity. This method may be applicable to the removal of other hollow objects within the gastric lumen.

Overtubes in gastrointestinal endoscopy

Gastrointestinal endoscopy is an evolving field kindled by technologic advances, scientific discoveries, and the innovative minds of endoscopists. The development and subsequent applications of overtubes in gastrointestinal endoscopy mirror this larger evolution. In this article, we review the development, applications, and complications associated with overtubes in gastrointestinal endoscopy.

A new endoscopic technique for the removal of gastric phytobezoars

BACKGROUND

There is no standardized method for the evacuation of gastric phytobezoars. Prior endoscopic attempts have used injected cellulase and various devices to disrupt bezoars. The efficacy of directed, large-channel suction using an endoscope for the removal of large gastric phytobezoars is the subject of this study.

METHODS

Three consecutive patients with large gastric bezoars were examined. Phytobezoar removal using a standard endoscope (GIF-100, Olympus) was attempted but unsuccessful. Each phytobezoar was successfully evacuated by directed suction through an endoscope with a large-diameter accessory channel (GIF-XT30, Olympus). Each patient was followed up for bezoar recurrence.

RESULTS

Rapid, complete bezoar evacuation was achieved at one session in all patients. Aspirated volumes were 500, 700, and 1000 mL. There were no procedure-related complications.

CONCLUSIONS

Endoscopic suction removal of gastric phytobezoars using a large-channel endoscope is efficacious and safe. Coupling directed endoscopic suction with other endoscopic techniques might be efficacious for removal of more complex bezoars.