Novel method using small-caliber endoscope and balloon overtube for removing gastrointestinal residue

The presence of gastrointestinal blood clots and food residue often makes emergent endoscopic procedures difficult [1] [2]. Removal procedures are conventionally performed using grasping forceps, but these techniques require long procedure times and leave behind large amounts of residue. Although a tube-assisted suction method has been recently reported [3], the ability to pass through a narrow space and the adequacy of suction with side-scope navigation seem limited due to poor followability. For this reason, we developed a novel method of gastrointestinal residue removal using existing instruments.

We conducted an experimental study on two beagle dogs with food jelly filling the upper and middle stomach ([Video 1]). The equipment used consisted of a balloon overtube (TS-12140; Fujifilm, Tokyo, Japan) and a small-caliber endoscope (EG-L580NM7; Fujifilm) ([Fig. 1]). First, a 10 × 10-mm cross-shaped incision was made at the base of the overtube ([Fig. 2]), and the endoscope was fixed 2 mm from the distal tip of the overtube through the incision hole and connected at four points using silk thread ([Fig. 3]). The maximum diameter of the suction channel was 4.9 mm, which is larger than the 3.2-mm forceps channel in a conventional endoscope. Next, the overtube was inserted into the stomach under visual observation via the endoscope. With this configuration, large amounts of residue were effectively aspirated through the channel ([Fig. 4]). Suctioning the superficial mucosa, which is unavoidable unless preventive measures are taken, interrupts the smooth suctioning procedure. We therefore found it useful to push the mucosa using a biopsy forceps to maintain a clear view throughout the procedure ([Fig. 5]). This procedure was successful in creating a clear operation field without any complications in both animals. The procedure time was 6 min on average.

Video 1 Suction equipment and procedure for the proposed novel, rapid, and safe method of removing upper gastrointestinal residue.

Fig. 1 The suction equipment used for this procedure, which includes a nasal endoscope and overtube.

Fig. 2 Detailed schematic of the equipment, including the suction channel with a 4.9-mm maximum diameter. The endoscope was inserted through the 10 × 10-mm cross-shaped incision at the base of the overtube.

Fig. 3 The endoscope was fixed 2 mm from the distal tip of the overtube and connected to the overtube at four points using silk thread.

Fig. 4 Endoscopic images showing the operation field before and after the suction method was applied: a before, b after.

Fig. 5 Pushing the mucosa using a biopsy forceps was useful to maintain a continuously clear view.

This experiment demonstrates that this novel method may be efficient for removing upper gastrointestinal residue.

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• References

• 1 Coleski R, Baker JR, Hasler WL. Endoscopic gastric food retention in relation to scintigraphic gastric emptying delays and clinical factors. Dig Dis Sci 2016; 61: 2593-2601
• 2 Watanabe H, Adachi W, Koide N. et al. Food residue at endoscopy in patients who have previously undergone distal gastrectomy: risk factors and patient preparation. Endoscopy 2003; 35: 397-401
• 3 Zeng X, Yan P, Ye L. et al. Tube-assisted suction: a novel technique for removing massive food residue during gastroscopy. Endoscopy 2019; 51: E73-E74