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DOI: 10.1055/a-1559-1863
Electrolyte-free gel immersion endoscopic submucosal dissection of gastric lesions
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Gel immersion endoscopy was developed to secure the visual field during ongoing gastrointestinal bleeding using the viscous rehydration supplement “OS-1 jelly” (Otsuka Pharmaceutical Factory, Tokushima, Japan) [1]. However, this includes electrolytes and needs replacement with gas or pure water before cauterization using monopolar devices to avoid electrical dispersion [1]. A new, dedicated electrolyte-free gel (Viscoclear; Otsuka Pharmaceutical Factory) allows effective coagulation within the gel [2], enabling usage during endoscopic submucosal dissection (ESD).
With the emergence of new strategies to conquer difficult ESD, the water (or saline) immersion technique [3] and pocket-creation method have become popular [4]. Inside the “pocket” during intraprocedural bleeding, gel immersion endoscopy easily secures the visual field with a small amount of gel [5].
We present two cases of ESD using gel immersion endoscopy ([Video 1]). In the first case with intraprocedural bleeding, we injected electrolyte-free gel via the accessory channel through the BioShield irrigator (US Endoscopy, Mentor, Ohio, USA) to secure the visual field. The bleeding point was identified and coagulated with hemostatic forceps within the gel ([Fig. 1]).
Video 1 Gastric gel immersion in endoscopic submucosal dissection with a new, dedicated electrolyte-free gel.
Qualität:
![](https://www.thieme-connect.de/media/endoscopy/202209/thumbnails/10-1055-a-1559-1863-i2615ev1.gif)
![Zoom Image](/products/assets/desktop/css/img/icon-figure-zoom.png)
In the second case, we demonstrate the combination of gel and saline immersion ESD. Saline immersion ESD is reportedly advantageous because of buoyancy; however, rapid reduction of visualization due to minor bleeding, trapped gas within the hood, or inefficient coagulation due to electrical dispersion can be challenging [3]. Gel immersion ESD maintains a clear visual field, especially in cases with the lesion on the lower side of gravity, where dirty water and blood collect easily. The viscosity of the gel prevents the direct flow of gas bubbles into the tip of the hood, and we can easily remove them by injecting a small amount of additional gel ([Fig. 2]).
![](https://www.thieme-connect.de/media/endoscopy/202209/thumbnails/10-1055-a-1559-1863-i2615ev2.jpg)
![Zoom Image](/products/assets/desktop/css/img/icon-figure-zoom.png)
Gel immersion ESD has the advantages of obtaining sufficient traction by buoyancy, maintaining a clear visual field regardless of lesion location, and enabling precision coagulation for hemostasis.
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Endoscopy E-Videos is an open access online section, reporting on interesting cases and new techniques in gastroenterological endoscopy. All papers include a high quality video and all contributions are freely accessible online. Processing charges apply (currently EUR 375), discounts and wavers acc. to HINARI are available.
This section has its own submission website at https://mc.manuscriptcentral.com/e-videos
Publikationsverlauf
Artikel online veröffentlicht:
15. Oktober 2021
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References
- 1 Yano T, Nemoto D, Ono K. et al. Gel immersion endoscopy: a novel method to secure the visual field during endoscopy in bleeding patients (with videos). Gastrointest Endosc 2016; 83: 809-811
- 2 Yano T, Ohata A, Hiraki Y. et al. Development of a gel dedicated to gel immersion endoscopy. Endosc Int Open 2021; 9: E918-E924
- 3 Yamamoto H, Hayashi Y, Despott EJ. The pocket-creation method for endoscopic submucosal dissection combined with saline-immersion: another potential option to overcome challenges in colorectal endoscopic submucosal dissection. Gastrointest Endosc 2019; 90: 288-289
- 4 Miura Y, Hayashi Y, Lefor AK. et al. The pocket-creation method of ESD for gastric neoplasms. Gastrointest Endosc 2016; 83: 457-458
- 5 Miura Y, Yano T, Takezawa T. et al. Gel immersion endoscopy simplifies hemostasis during endoscopic submucosal dissection using the pocket-creation method. Endoscopy 2018; 50: E294-E295