Tube-assisted suction: a novel technique for removing massive food residue during gastroscopy
18 January 2019 (online)
A 44-year-old man with achalasia was scheduled to undergo peroral endoscopic myotomy for recurrence after Heller myotomy. Massive food residue was observed in the lower esophagus, despite repeated and adequate fasting ([Fig. 1]). Repeated irrigation and suction by the endoscope (GIF-Q260J; Olympus, Tokyo, Japan) failed to remove the food residue. Grasping forceps (basket type, FG-16L-1; Olympus) did not work either. Therefore, tube-assisted suction was performed ([Video 1]).
Video 1 Tube-assisted suction for the removal of massive food residue during gastroscopy.
A soft, plastic tube (outer diameter 5 mm) with several side apertures was tied along the side of the scope. The head of the tube was positioned approximately 3 mm beyond the tip of the scope ([Fig. 2]). The other end of the tube was connected to a vacuum extractor. Then, the scope with the attached tube was inserted smoothly. When the food residue was observed, irrigating and suction were continued until no food residue remained. Eventually, a clear field was achieved ([Fig. 3]).
Patients who undergo endoscopy after gastric surgery usually have some food residue   , similarly to patients with achalasia, which interferes with endoscopic observation and detection of lesions . No specific method has been reported to remove massive food residue during gastroscopy. Patient preparation for the day before the endoscopic procedures is emphasized: sufficient fasting time (more than 18 hours)  and a liquid diet plus gastrokinetic agents (i. e. cisapride, domperidone, and aclatonium napadisilate) . However, attempts to obtain a satisfactory field may still end in failure. Tube-assisted suction is a novel technique to solve this problem. The tube is a common vacuum suction tube that is available in most medical institutions. This technique minimizes discomfort resulted from repeated fasting. Furthermore, use of this simple addition may avoid a delay in emergency endoscopic treatment or having to postpone treatment.
In conclusion, we believe that tube-assisted suction is an effective, simple, and timesaving way for removing massive food residue.
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* These authors contributed equally to this work.
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