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9 protocols using sif h290s

1

Advances in Short-Balloon Enteroscopy Techniques

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All treatments performed during this study involved a short SBE. Two types of scope were used: SIF-Y0004 (prototype) and SIF-H290S (new model; Olympus Medical Systems, Tokyo, Japan), which have a working length of 152 cm and a 3.2-mm working channel.
Table 1shows the specifications of the endoscopes, including the SIF-Q260 (Olympus Medical Systems), which is the conventional SBE. Our facility has used the SIF-H290S since March 2016 (
Fig. 1).
The new short SBE has two features: passive bending and high-force transmission. There is a passive bending section behind the scope curvature (
Fig. 2). If the scope is at the intestinal tract wall when passing through a sharp flexure, then the passive bending section allows the scope to smoothly bend along the bend of the wall, making it possible to move forward. High-force transmission capabilities make it possible to perform torque operations efficiently and to provide finer scope control. Therefore, it is also useful for bile duct cannulation and subsequent treatment procedures (
Fig. 2).
All ERCP treatments were performed using CO
2insufflation, and we used a distal attachment cap (D-201-10704; Olympus Medical Systems) in all cases. The patient was generally in the prone position; when insertion was difficult, the position was changed or abdominal compression was used.
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2

Diagnosis and Management of HJAS

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Patients were followed up with laboratory studies every 1–3 months and contrast‐enhanced CT was performed every 3 months for 2 years and every 6 months thereafter for a total of 5 years after resection. In cases with suspected HJAS, endoscopic retrograde cholangiopancreatography (ERCP) with single‐balloon‐assisted enteroscopy (SBE) was performed. Two types of SBE were used during the study period (SIF‐Q260; working length, 2000 mm; channel diameter, 2.8 mm, and SIF‐H290S; working length, 1520 mm; channel diameter, 3.2 mm; Olympus Medical Systems). All procedures were performed by experts or by trainees under their direct guidance. Cases with benign HJAS were treated with balloon dilation with or without biliary stent placement. Follow‐up was conducted up to June 30, 2022.
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3

Comparative Evaluation of Enteroscope Models

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We used four models of enteroscopes: SIF-Y0004, SIF-Y0004-V01, and SIF-Y0015, which were prototype enteroscopes, and SIF-H290S, which was a commercially available model (Olympus Medical Systems, Tokyo, Japan). All enteroscopes had a working length of 1520 mm, a working channel diameter of 3.2 mm, and a distal end outer diameter of 9.2 mm. With the exception of SIF-Y0004, all enteroscopes had passive bending and high force transmission functions. A sliding tube with a working length of 880 mm was used (ST-SB1S, Olympus Medical Systems). A tip cap (D-201-10704, Olympus Medical Systems) was used in all patients.
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4

Endoscopic Evaluation and Dilation of Intestinal Strictures in Crohn's Disease

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BAE was performed for endoscopic evaluation, diagnosis, and treatment of small intestinal strictures including the terminal ileum in CD patients. We used the single-balloon endoscopy system (SIF-Q260 or SIF-H290S; Olympus, Tokyo, Japan) for BAE. The endoscopic examination was performed as previously reported [21 (link)]. Indications for EBD were determined according to the following criteria; stricture that a 9.2 mm-diameter endoscope cannot pass through, stricture length < 5 cm, absence of fistula, absence of deep ulcer, and absence of a steep curvature making dilation difficult [11 (link)]. A through-the-scope balloon catheter (CRE Wire-guided Balloon Dilators; Boston Scientific, Marlborough, MA, USA) was used for EBD. The balloon dilator was inserted within the stricture and inflated under direct vision for 2 min.
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5

Balloon-assisted enteroscopy for drainage

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A single-balloon enteroscope (SIF-H290S; Olympus Medical, Tokyo, Japan), a distal attachment (D-201-10704; Olympus Medical) and an overtube (ST-SB1S; Olympus Medical) was used as a BAE in this study. This enteroscope has a 9.2 mm distal end diameter, a 152 cm working length and a 3.2 mm working channel. A 6 Fr or 7.2 Fr END tube (SilkyPass; Boston Scientific, Marlborough, MA, USA) was used for external drainage. A 7 Fr double-pigtail stent (Through & Pass; Gadelius Medical, Tokyo, Japan, Zimmon Biliary Stent Sets; Cook Medical, Bloomington, IN, USA) was used when a plastic stent was selected for internal drainage. Several types of uncovered SEMS with 9 Fr delivery systems were used depending on the time of study period: Niti-S Colonic stent (TaeWoong Medical, Gyeonggi-do, South Korea), Niti-S Pyloric/Duodenal stent (TaeWoong Medical), HANAROSTENT Naturfit DUO stent (Boston Scientific), JENTLLY NEO Duodenal stent (Japan Lifeline, Tokyo, Japan), and NEXENT duodenal stent (Next Biomedical, Incheon, South Korea). The diameter of Niti-S Colonic stemt was 18 mm, while all other SEMS had diamaters of 22 mm. The lengths of uncovered SEMS were 60, 80, 100, 120 mm.
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6

ERCP: Comprehensive Endoscopic Techniques

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ERCP was conducted by an experienced gastroenterologist (a physician with at least 7 years total and 4 years ERCP experience) using the Olympus TJF260V or SIF‐H290S (Olympus Medical). Sedation was administered transvenously, using flunitrazepam or dexmedetomidine hydrochloride. A breakdown of the ERCP procedures is as follows: endoscopic sphincterotomy, endoscopic papillary balloon dilation, endoscopic papillary large balloon dilation, endoscopic pancreatic sphincterotomy, endoscopic papillectomy (EP), peroral cholangioscopy, intraductal ultrasonography, stone removal (basket catheter, balloon catheter, and endoscopic mechanical lithotripsy), endoscopic biliary stent, and endoscopic pancreatic duct stent. These procedures were performed according to ERCP indications. Spontaneous pancreatic duct plastic stent placement was performed if the pancreatic duct was accidentally cannulated more than once during the ERCP. The endoscopic pancreatic duct stent (with the flap) was placed in all cases where the EP was conducted.
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7

Endoscopic Retrograde Cholangio-Pancreatography Techniques

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Expert endoscopists with more than five years of experience in therapeutic endoscopy or trainees under direct supervision performed the procedures. ERCPs in patients without surgically altered anatomies were performed using side-viewing duodenoscopes (JF-260V, TJF-260V, or TJF-Q290V; Olympus Corporation). ERCPs in patients with surgically altered anatomies (Fig. 2) were performed using single-balloon enteroscopes (SBE) (SIF-H290S or SIF-Q260; Olympus Corporation).
An ERCP catheter (MTW Endoskopie Manufaktur) and a Visiglide 2 0.025-inch angled guidewire (Olympus Corporation) were used as the first ERCP catheter and guidewire, respectively. Although the precise timing for switching to TRUEtome was based on the endoscopist's discretion, TRUEtome was solely used in difficult cannulations defined by the European Society of Gastrointestinal Endoscopy as follows: >5 contacts with the papilla, >5 minutes to cannulation, or >1 unintended pancreatic duct cannulation.9 (link) While indications for using TRUEtome were mainly determined by procedural reports, one of the authors (TO) reviewed videos for each procedure and determined the attributes of difficult cannulations.
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8

Endoscopic Imaging Protocol Comparison

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A forward-viewing endoscope (GIF-H290, GIF-2TQ260M, PCF-PQ260I, PCF-H290I, PCF-H290ZI, CF-HQ290ZI, TGF-UC260J, and SIF-H290S; Olympus Medical Systems, and EN450BI5, and EI530B; Fujifilm Medical, Tokyo, Japan) was used in all sessions.
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9

Endoscopic Biliary Stricture Assessment and Sampling

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After selective biliary cannulation with contrast or wire guidance, cholangiography was performed with a contrast medium to evaluate the biliary stricture. A 0.025‐inch angle‐tip guidewire (Visiglide2; Olympus and EndoSelector; Boston Scientific Japan) or a 0.035‐inch angle‐tip guidewire (RevoWave SeekMaster; Piolax Medical Devices, Inc.) was advanced through the biliary stricture, and then brush cytology or Trefle‐assisted tissue acquisition was performed over the guidewire before drainage catheter placement. For patients for whom endoscopic sphincterotomy (EST) was deemed necessary, it was done with a sphincterotome (KD‐V411M‐0725; Olympus Medical Systems) prior to specimen collection. Backward‐oblique viewing duodenoscope (JF260V, TJF 260V, and TJF‐Q290V; Olympus Medical Systems and ED‐580T; Fujifilm Medical Co.) was used in patients with normal anatomy, and single balloon enteroscope (SIF‐H290S; Olympus Medical Systems) or double balloon enteroscope (EI‐580BT; Fujifilm Medical Co.) in patients with the surgically altered anatomy.
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