A 74-year-old patient with iron deficiency anemia presented for an outpatient upper
endoscopy. Two 20–30 mm pedunculated polyps were detected in the gastric body ([Fig. 1]) and removed with a hot snare. Polypectomy bleeding prompted hemostatic clip placement.
However, bleeding persisted, and endoscopic visualization was compromised. The endoscope
was exchanged for one with a larger suction channel, but visualization remained inadequate.
Therefore, the Pure-Vu EVS System (Motus GI, Tirat Carmel, Israel), a US Food and
Drug Administration-approved oversleeve-based intraprocedural cleansing device intended
for use in the colon ([Fig. 2]), was used to improve visualization, allowing further hemostatic interventions.
Fig. 1 Two 20–30 mm pedunculated polyps were found in the gastric body.
Fig. 2 Intraprocedural cleansing device. The over-the-scope device was loaded onto a colonoscope.
The device contains five irrigation jets and a large suction channel, and does not
inhibit the use of the colonoscope’s working channel.
The endoscope was removed to load the device, which contains five irrigation jets
and a large-caliber suction channel attached to a device-specific workstation. The
device leaves the working channel free. With the device in place, esophageal intubation
was performed without difficulty. The powerful irrigation and suction capabilities
of the device allowed rapid clearance of blood and clot ([Fig. 3], [Video 1]). Additionally, a large clot was suctioned into the device suction channel, and
utilizing a manual purge function, the clot was deposited in the gastric antrum. With
improved visualization, epinephrine was injected and additional hemostatic clips were
placed ([Fig. 4]). To prevent rebleeding, hemostatic spray was applied ([Fig. 5]). With the working channel free and endoscope maneuverability uninhibited, the device
was left in place throughout the procedure. Ultimately, definitive hemostasis was
achieved, and there were no adverse events. Pathology revealed benign foveolar hyperplastic
polyps.
Fig. 3 Device irrigation jets. The jets of the intraprocedural cleansing device cleansed
the stomach wall.
A colonic intraprocedural cleansing device was used to improve endoscopic visualization
during upper gastrointestinal bleeding.Video 1
Fig. 4 Hemostasis after endoscopic clipping. View of the polypectomy site after multiple
hemostatic clips were placed to achieve hemostasis.
Fig. 5 Hemostatic spray application to the polypectomy site. At the end of the procedure,
hemostatic spray was applied to the polypectomy site to prevent rebleeding. This was
performed easily with the device in place as it does not block the working channel
of the endoscope.
While this intraprocedural cleansing system is known to be effective for improving
colonic bowel preparation [1]
[2]
[3], this is the first reported case of using this device in the upper gastrointestinal
tract. Use of the device was warranted given failure of other conventional methods
to improve visualization. The device was an effective method for rapidly improving
visualization and allowing for timely hemostatic interventions in the setting of vigorous
iatrogenic upper gastrointestinal bleeding.
Endoscopy_UCTN_Code_TTT_1AO_2AD
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