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

Yano, Tomonori; Takezawa, Takahito; Hashimoto, Kosei; Ohmori, Ayako; Shinozaki, Satoshi; Nagayama, Shiho; Sakamoto, Hirotsugu; Mıura, Yoshimasa; Hayashi, Yoshikazu; Sunada, Keijiro; Lefor, Alan Kawarai; Yamamoto, Hironori

doi:10.1055/a-1400-8289

Cited by 25 publications

(29 citation statements)

References 9 publications

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“…This makes it easier to identify the source of bleeding and helps to ensure endoscopic hemostasis. It is also reported to be useful for gastrointestinal bleeding at various sites [ 13 ]. In addition, there are several case reports, including ours, on the application of this gel for endoscopic submucosal dissection and EMR [ 14 , 19 – 22 ].…”

Section: Discussionmentioning

confidence: 99%

“…In such cases, it is sometimes difficult to perform UEMR because it requires a large amount of water and takes a long time. In 2021 a new endoscopic procedure and treatment gel product (VISCOCLEAR®; Otsuka Pharmaceuticals Factory, Tokushima, Japan) was launched in Japan and reported to be useful for identifying active sources of gastrointestinal hemorrhage [ 11 – 13 ]. Unlike water, this gel product does not mix with intestinal fluids or blood, thus ensuring a good view of the gastrointestinal tract.…”

Section: Introductionmentioning

confidence: 99%

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Gel Immersion Endoscopic Mucosal Resection (EMR) for Superficial Nonampullary Duodenal Epithelial Tumors May Reduce Procedure Time Compared with Underwater EMR (with Video)

Yamashina

Shimatani

Takahashi

et al. 2022

Gastroenterology Research and Practice

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Background/Aims. Underwater endoscopic mucosal resection (UEMR) has recently attracted attention as a safe and effective method for superficial nonampullary duodenal epithelial tumors (SNADETs). However, water is a fluid and it does not remain in all areas, and because it mixes easily with other substances, it sometimes becomes cloudy and reduces visibility. A new endoscopic gel product that does not mix with fluids and tends to remain in the injected area has recently been applied to EMR and is known as gel immersion EMR (GIEMR) or under-gel EMR. Here, we evaluated the endoscopic outcomes of UEMR and GIEMR. Materials and Methods. This was a retrospective cohort study conducted in two municipal hospitals. We identified 24 patients with SNADETs of 3–18 mm in diameter who underwent UEMR or GIEMR. One lesion was excluded from the analysis because it was found to be in the stomach after surgery. The primary outcome was procedure time. Results. GIEMR significantly reduced the procedure time compared with UEMR (5 min vs. 10 min, P = 0.016 ). There was no significant difference between the UEMR and GIEMR groups for en bloc resection rate (93% vs. 100%, P = 1.0 ) and R0 resection rate (57% vs. 80%, P = 0.39 ). No serious complications were observed in either group. Conclusions. GIEMR of SNADET has the potential to reduce procedure time compared with UEMR and may be particularly effective in areas where immersion in water is difficult.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Gel Immersion Endoscopic Mucosal Resection (EMR) for Superficial Nonampullary Duodenal Epithelial Tumors May Reduce Procedure Time Compared with Underwater EMR (with Video)

Yamashina

Shimatani

Takahashi

et al. 2022

Gastroenterology Research and Practice

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“…Gel immersion endoscopy is effective for a narrow lumen, as these are often filled with blood. This blood can easily be replaced with gel 1 . The present report describes a case of diverticular bleeding in the sigmoid colon that was successfully treated via gel immersion endoscopy.…”

Section: Brief Explanationmentioning

confidence: 95%

“…When identifying the source of gastrointestinal bleeding, securing the visual field is difficult because the injected water rapidly mixes with the blood and residue. The use of gas insufflation to displace luminal contents causes significant discomfort and makes endoscope operation difficult 1 . Gel immersion endoscopy has recently been reported as a useful method when bleeding occurs during the endoscopic treatment 2,3 .…”

Section: Brief Explanationmentioning

confidence: 99%

Case of gel immersion endoscopy: Efficacy of identification and achieving hemostasis for diverticular hemorrhage in the sigmoid colon

Teshima

Yamashita

Oka

2022

Digestive Endoscopy

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“…Because injected water mixes immediately with blood, the visual field becomes cloudy. To solve this problem, the gel immersion method was developed [1,2]. After injecting clear gel into the gastrointestinal lumen via the accessory channel instead of water, the visual field can be secured within the space occupied by the clear gel.…”

Section: Introductionmentioning

confidence: 99%

Factors contributing to changes in viscosity and flow rate of a dedicated gel for gel immersion endoscopy

et al. 2022

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Background and study aims Gel immersion endoscopy is a novel technique for securing the visual field during endoscopy. Clinical application of a dedicated gel for this technique with an appropriate viscosity to prevent mixing with blood and its efficacy was reported. The aim of this study was to evaluate changes in gel viscosity and flow rate under different conditions. Methods The viscosity of the gel after injection and flow rate were measured under various conditions changing the injection route and method. Gel viscosity was measured at 25, 10, and 4 °C. Results A decrease in gel viscosity was found when the gel was injected via the water jet channel compared to the accessory channel. The flow rate and decrease in viscosity of the gel injected via the water jet channel were 220 mL/min and 63.2 %, while when injected via the accessory channel with a clip device inserted were 560 mL/min and 35.8 %. When the gel was kept at a low temperature, the viscosity increased. Conclusions Gel injection via the accessory channel should be the first choice for efficient use considering the viscosity and flow rate.

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

Cited by 25 publications

References 9 publications

Gel Immersion Endoscopic Mucosal Resection (EMR) for Superficial Nonampullary Duodenal Epithelial Tumors May Reduce Procedure Time Compared with Underwater EMR (with Video)

Gel Immersion Endoscopic Mucosal Resection (EMR) for Superficial Nonampullary Duodenal Epithelial Tumors May Reduce Procedure Time Compared with Underwater EMR (with Video)

Case of gel immersion endoscopy: Efficacy of identification and achieving hemostasis for diverticular hemorrhage in the sigmoid colon

Factors contributing to changes in viscosity and flow rate of a dedicated gel for gel immersion endoscopy

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