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

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]).

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.

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.

Publikationsverlauf

Eingereicht: 12. Oktober 2020

Angenommen: 15. Februar 2021

Artikel online veröffentlicht:
21. Juni 2021

• References

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