CC BY-NC-ND 4.0 · Endosc Int Open 2021; 09(07): E1123-E1127
DOI: 10.1055/a-1400-8289
Innovation forum

Gel immersion endoscopy: Innovation in securing the visual field – Clinical experience with 265 consecutive procedures

Tomonori Yano
1  Division of Gastroenterology, Department of Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
,
Takahito Takezawa
1  Division of Gastroenterology, Department of Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
,
Kousei Hashimoto
1  Division of Gastroenterology, Department of Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
,
Ayako Ohmori
1  Division of Gastroenterology, Department of Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
,
Satoshi Shinozaki
2  Shinozaki Medical Clinic, Utsunomiya, Tochigi, Japan
,
Manabu Nagayama
1  Division of Gastroenterology, Department of Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
,
Hirotsugu Sakamoto
1  Division of Gastroenterology, Department of Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
,
Yoshimasa Miura
1  Division of Gastroenterology, Department of Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
,
Yoshikazu Hayashi
1  Division of Gastroenterology, Department of Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
,
Keijiro Sunada
1  Division of Gastroenterology, Department of Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
,
Alan Kawarai Lefor
3  Department of Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan
,
Hironori Yamamoto
1  Division of Gastroenterology, Department of Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
› Author Affiliations

Introduction

During endoscopy, especially in patients with gastrointestinal bleeding, it is often difficult to secure the visual field. Although water immersion techniques are sometimes used to mitigate this situation [1] [2] [3], maintenance of the visual field is often difficult because the infused/injected water rapidly mixes with any luminal blood and/or residue. Poor preparation before colonoscopy also makes it difficult to secure the visual field when using water immersion or water exchange techniques. The use of gas insufflation to displace luminal contents can cause significant discomfort and difficult endoscope insertion. It is also often impossible to adequately aspirate blood, clots and residue. Although positional changes may improve visualization through gravity, this strategy is also ineffective at times.

To solve these problems, we developed an innovative technique called “gel immersion endoscopy” [4]. Clear gel with an appropriate viscosity (which prevents rapid luminal mixing) is injected/infused through the accessory channel, instead of water. The viscous gel displaces luminal blood, clots and residue ([Fig. 1]). In the space occupied by the gel, we can then easily secure the visual field and perform endotherapy calmly and effectively, even in patients with massive arterial bleeding and/or poor preparation ([Video 1]).

Zoom Image
Fig. 1 Any infused/injected water rapidly mixes with any luminal blood and/or residue. But the viscous gel displaces luminal blood, clots and residue. Consequently, gel immersion endoscopy clarifies a bleeding source.

Video 1 Two patients with gastrointestinal bleeding treated by using gel immersion endoscopy.


Quality:

We use a jelly-like drink “OS-1 jelly” (Otsuka Pharmaceutical Factory, Tokushima, Japan) for this technique. This is a dedicated rehydration-supplement for patients with dehydration which consists of a gelling agent (polysaccharide-thickener), electrolytes, carbohydrates, and water. Since it is a food-supplement, it is considered safe for use within the digestive tract.

This technique was reported with small number of procedures [4] [5] [6] [7]. However, the effectiveness and safety of this technique has not yet been studied in a large number of procedures. The aim of this study is to clarify the effectiveness and safety of the gel immersion endoscopy technique for the management of gastrointestinal bleeding and/or endoscopy after poor preparation.



Publication History

Received: 12 October 2020

Accepted: 15 February 2021

Publication Date:
21 June 2021 (online)

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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