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Efficacy of an assistive guide tube for improved endoscopic access to gastrointestinal lesions: an in vivo study in a porcine model

  • Dong Seok Lee (Department of Gastroenterology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Jeong-Sik Byeon (Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Sang Gyun Kim (Department of Gastroenterology, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Ji Won Kim (Department of Gastroenterology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine) ;
  • Kook Lae Lee (Department of Gastroenterology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine) ;
  • Ji Bong Jeong (Department of Gastroenterology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine) ;
  • Yong Jin Jung (Department of Gastroenterology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine) ;
  • Hyoun Woo Kang (Department of Gastroenterology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine)
  • Received : 2022.06.04
  • Accepted : 2023.01.02
  • Published : 2024.01.30

Abstract

Background/Aims: Guide tube-assisted endoscopy for procedures that require repeated endoscopic access is safer and more effective than conventional endoscopy. However, its effectiveness has not been confirmed in animal studies. We assessed the usefulness of guide tube-assisted endoscopic procedures in an in vivo porcine model. Methods: Five different guide tube-assisted endoscopic procedures were performed by experienced endoscopists on a pig weighing 32 kg. To evaluate the efficacy of these procedures, we compared the endoscopic approach time when a guide tube was used to that when it was not. Additional endoscopic procedures using a guide tube were performed, including multiple foreign body extractions, multiple polypectomies, and multiple submucosal dissections. To evaluate safety, we compared the insertion force into the proximal esophagus between the guide tube and conventional overtube methods. Results: Using the endoscopic approach with a guide tube required a shorter average approach time to reach the three target lesions than when using the endoscopic approach without a guide tube (p<0.001). Compared to the conventional overtube method, the guide tube method produced a lower average resistance during insertion into the upper esophagus (p<0.001). Conclusions: Guide tube-assisted endoscopic procedures are effective and safe for repeated endoscopic access in an in vivo porcine model.

Keywords

Acknowledgement

This work was supported by a clinical research grant-in-aid from Seoul National University Boramae Medical Center (03-2019-4) and the National Center of Efficacy Evaluation for the Development of Health Products Targeting Digestive Disorders.

References

  1. Lee DS, Kim BG, Lee KL, et al. Technical feasibility of a guidetube for various endoscopic procedures in human gastrointestinal simulators. Clin Endosc 2019;52:247-251.  https://doi.org/10.5946/ce.2018.147
  2. Holderman WH, Etzkorn KP, Patel SA, et al. Endoscopic findings and overtube-related complications associated with esophageal variceal ligation. J Clin Gastroenterol 1995;21:91-94.  https://doi.org/10.1097/00004836-199509000-00005
  3. Dinning JP, Jaffe PE. Delayed presentation of esophageal perforation as a result of overtube placement. J Clin Gastroenterol 1997;24:250-252.  https://doi.org/10.1097/00004836-199706000-00014
  4. Levy R, Kaur S, Uzer M. Separation of an overtube from the bite block during band ligation of esophageal varices. Gastrointest Endosc 1997;46:66-68.  https://doi.org/10.1016/S0016-5107(97)70213-X
  5. Jeffries MA, Scheiman JM. Overtube separation. Gastrointest Endosc 1998;47:435-436.  https://doi.org/10.1016/S0016-5107(98)70238-X
  6. ASGE Technology Committee, Tierney WM, Adler DG, et al. Overtube use in gastrointestinal endoscopy. Gastrointest Endosc 2009;70:828-834.  https://doi.org/10.1016/j.gie.2009.06.014
  7. Perencevich M, Stoffel EM. A multidisciplinary approach to the diagnosis and management of multiple colorectal polyps. Gastroenterol Hepatol (N Y) 2011;7:420-423. 
  8. Wang X, Su S, Chen Y, et al. The removal of foreign body ingestion in the upper gastrointestinal tract: a retrospective study of 1,182 adult cases. Ann Transl Med 2021;9:502. 
  9. Goldschmiedt M, Haber G, Kandel G, et al. A safety maneuver for placing overtubes during endoscopic variceal ligation. Gastrointest Endosc 1992;38:399-400.  https://doi.org/10.1016/S0016-5107(92)70453-2
  10. Chen CY, Lin CY, Chang TT, et al. A simple maneuver for placing an overtube during endoscopic variceal ligation. Gastrointest Endosc 1995;41:83-84.  https://doi.org/10.1016/S0016-5107(95)70289-X
  11. Pai RD, Carr-Locke DL, Thompson CC. Endoscopic evaluation of the defunctionalized stomach by using ShapeLock technology (with video). Gastrointest Endosc 2007;66:578-581.  https://doi.org/10.1016/j.gie.2007.02.062
  12. Raju GS, Pasricha PJ. ShapeLock: a rapid access port for redeployment of a colonoscope into the proximal colon to facilitate multiple polypectomies in a single session. Gastrointest Endosc 2005;61:768-770. https://doi.org/10.1016/S0016-5107(05)00286-5