Gastrointestinal Residue Removal Using a Balloon Overtube under Ultrathin Endoscopic Navigation: Ex Vivo and In Vivo Experimental Studies.

Kazuhiro Kozuka,Hideki Kobara,Noriko Nishiyama,Akihiro Kondo,Naoya Tada,Taiga Chiyo,Keiichi Okano,Takanori Matsui,Nobuya Kobayashi,Kensuke Kumamoto,Shintaro Fujihara,Akira Nishiyama,Tingting Shi,Koji Fujita,Joji Tani,Tsutomu Masaki,Tatsuo Yachida,Kazushi Deguchi,Tadayuki Takata

doi:10.3390/jcm10173796

Abstract

Pooled gastric residues involving blood clots and food interrupt appropriate endoscopic intervention, leading to poor outcomes in endoscopic hemostasis and lifesaving. However, procedures and devices that enable the effective removal of gastrointestinal residues remain unsatisfactory. This study aimed to evaluate the efficacy and safety of our developed suction method in ex vivo and in vivo studies. We created a hand-made device with a large suction diameter, consisting of a balloon overtube and an ultrathin endoscope for navigation. In the ex vivo study, we compared the success rate and the suctioning time for four types of simulated residue between a standard endoscope and our device. Our device had s significantly higher suction ability and a shorter procedure time than the standard endoscope. The subsequent in vivo animal study involved five beagle dogs that were administered with food jelly to mimic gastric residue. Suction was performed twice for five dogs (ten attempts). The outcome measure was the successful procedure rate; secondary outcomes were procedure-associated complications and procedure time. The procedure was successful in all attempts, without any complications. The mean procedure time was 5 min. This novel method enabled the efficient and safe removal of gastric residue, and our findings will likely lead to the development of the instrument.

Highlights

The ex vivo study that designed four types of simulated residue, comprising gels or solid substances, was the first and novel study evaluating the usefulness of an endoscopic food residue removal method
Our method was superior to suctioning using a standard endoscope in terms of successful removal and procedure time in ex vivo study; our method provided a limited ability when suctioning a 3 mm2 solid substance
The largediameter suction channel using the overtube was efficacious for GI residue removal in the in vivo animal study

Summary

Introduction

Despite the remarkable developments in upper gastrointestinal endoscopy-related procedures in recent years, more advanced and delicate endoscopic techniques are still required. Clinicians often encounter situations in which endoscopic treatment is made difficult by the presence of gastrointestinal (GI) residues such as blood clots and food [1,2,3]. The accumulation of a large amount of GI residue interferes with the endoscopic operation field and may lead to a decreased therapeutic completion rate and increased rate of complications. It is necessary to remove the GI residue and secure a sufficient

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