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. 2021 Mar 23;6(4):184-186.
doi: 10.1016/j.vgie.2020.11.019. eCollection 2021 Apr.

Hemostasis of an actively bleeding lesion at the ileocecal valve by low-pressure endoscopy using the gel immersion technique

Keitaro Yano  1 , Tomonori Yano  1 , Manabu Nagayama  1 , Alan Kawarai Lefor  2 , Hironori Yamamoto  1
Affiliations

Hemostasis of an actively bleeding lesion at the ileocecal valve by low-pressure endoscopy using the gel immersion technique

Keitaro Yano et al. VideoGIE. .
No abstract available

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Figures

Figure 1
Figure 1
BioShield irrigator enables additional injection of gel with a therapeutic device through the accessory channel.
Figure 2
Figure 2
A, It was difficult to secure the visual field because of a large amount of bloody fluid and fresh clots. B, Injecting gel appropriately, a transparent space was maintained between the tip of the endoscope and the intestinal wall, and insertion while maintaining a good visual field was possible.
Figure 3
Figure 3
A, A fresh blood clot was found near the ileocecal valve. B, Almost no bloody fluid was found in the ileum.
Figure 4
Figure 4
A, Injecting gel at the cecum revealed an actively bleeding lesion at the lower lip of the ileocecal valve. B, The viscosity of the gel slowed the bleeding, and we could easily achieve hemostasis with clips.
Figure 5
Figure 5
A, Colonoscopy at the previous facility suggested that hyperinflation increased the pressure inside the large intestine, causing bloody fluid to reflux into the ileum. Therefore, fresh blood flowing from the proximal side was seen in the terminal ileum, and the patient was transferred to our hospital with suspected “small intestinal bleeding.” B, By using gel to secure the visual field and decreasing the pressure in the large intestine, we could suppress the reflux of blood into the ileum. Therefore, almost no bloody fluid was found in the ileum, and we could easily identify the source of bleeding.
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References

    1. Yano T., Nemoto D., Ono K. Gel immersion endoscopy: a novel method to secure the visual field during endoscopy in bleeding patients. Gastrointest Endosc. 2016;83:809–811. - PubMed

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