The following equipment was used: gastroscope (Q260J; Olympus, Tokyo, Japan), over-the-scope clip (OTSC) system and Twin Grasper (TG) forceps (Ovesco Endoscopy GmbH, Tübingen, Germany), hemoclips (HX-610–090L; Olympus), endoscopic variceal ligation device (MD-48720U; Sumius, Tokyo, Japan), loop cutter (FS-5L-1; Olympus), endoscopic knives [DualKnife (KD-650 L); Olympus and ITknife2 (KD-611 L); Olympus], hemostatic forceps (FD-410 LR; Olympus), glycerol for injection (Chugai Pharmaceutical Co., Ltd., Tokyo, Japan), carbon dioxide insufflation device (UCR; Olympus), and electrosurgical unit (VIO 300 D; Erbe Elektromedizin, Tübingen, Germany). The settings for EFTR were as follows: cut mode, Endocut I, effect 2, duration 3, interval 2 for mucosal incision; coagulation mode, Swift Coag, effect 3, 80 W for submucosal trimming and full-thickness resection; and Soft Coag, effect 6, 80 W for hemostasis.
Hx 610 090l
Manufactured by Olympus
Sourced in Japan
The HX-610-090L is a lab equipment product manufactured by Olympus. It is designed for general laboratory use. The detailed specifications and core function of this product are not available at this time.
Automatically generated - may contain errors
Lab products found in correlation
Hx 610 135, by Olympus (4 mentions)
Pcf h290i, by Olympus (2 mentions)
D 201 12704, by Olympus (2 mentions)
Hx 600 090l, by Olympus (2 mentions)
Hx 600 135, by Olympus (2 mentions)
Pcf q260azi, by Olympus (2 mentions)
Md 48710 evl device, by Sumitomo Bakelite (2 mentions)
Pcf q260ji, by Olympus (2 mentions)
Dualknife kd 650l, by Olympus (1 mentions)
Vio300d, by Erbe (1 mentions)
It knife 2, by Olympus (1 mentions)
Fd 410lr, by Olympus (1 mentions)
Kd 611l, by Olympus (1 mentions)
D 201 13404, by Olympus (1 mentions)
Gif h260j, by Olympus (1 mentions)
Cf h260, by Olympus (1 mentions)
Vio 200s, by Erbe (1 mentions)
Kd 650q, by Olympus (1 mentions)
Nm 200l 0423, by Olympus (1 mentions)
Hx 1 10ur, by Olympus (1 mentions)
9 protocols using hx 610 090l
1
Endoscopic Full-Thickness Resection Technique
2
Locating and Confirming Gastric Clip Placement
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Because the location of the endoscopic clip (HX-610–090L, Olympus, Tokyo, Japan) was not visible through the laparoscope, the surgeon used a surgical device to sweep the stomach wall. At this time, we could find the position of the clip with the sound and feeling of touch within a few minutes and attached a metallic vessel clip (176630, Covidien, USA) to the peritoneal side of the gastric wall, which was presumed to be the position of the endoscopic metallic clip. After the laparoscopic clips were applied, intraoperative radiographies were obtained to confirm the location of the clips (Fig. 3 ). The proximal resection line was then determined in accordance with the correlation between the endoscopic clips and laparoscopic clips. Thereafter, the surgeon drew a resection line on the serosal surface using gentian violet (pyoktanin blue solution) based on the intraoperative radiography (Fig. 4 ). After resecting the stomach, the surgeon moved the resected specimen out of the body and confirmed the grossly negative margins by opening the specimen and consequently identifying the metallic clips (Fig. 5 ). Frozen sectioning was not performed during the surgery when the gross margin seemed sufficient. When sufficient proximal margins were not obtained or tumor cells were present in the frozen section, additional resection was performed
3
Endoscopic Submucosal Dissection Technique
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All procedures were performed using a colonoscope (CF-H260; Olympus, Japan) with a transparent cap (D-201-13404; Olympus, Japan) and a gastroscope (GIF-H260J; Olympus, Japan) with a distal attachment (ND-201-11804; Olympus, Japan). A Dual knife (KD-650Q; Olympus, Japan) was used during all ESD procedures. A high-frequency electrosurgical generator (VIO 200S; ERBE, Germany) was set up. An injection needle (NM-200L-0423; Olympus, Japan) was used to lift up the lesion. Hot biopsy forceps (FD-1U-1; Olympus, Japan) or endoscopic metal clips (HX-610-090L; Olympus, Japan) were used to stop bleeding. A mixture of 100 ml of 10% glycerol solution containing 2 ml of methylthioninium chloride and 1 mg of 0.002% epinephrine was used as the injection solution [14 (link)].
4
Endoscopic Mucosal Defect Closure
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Whether clipping was used to close the defect was decided by the endoscopists’ preferences. After ER, the mucosal defect was closed using clips (HX-610-090L; Olympus Medical Systems Co., Tokyo, Japan) delivered by a clip-fixing device (HX110UR; Olympus Medical Systems). Complete closure was defined as an invisible mucosal defect after clipping.
5
Fluorescent Hemostatic Clip Fabrication
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The fluorescent clip developed in this study consists of a commercially available hemostatic clip (HX-610-090L, Olympus Medical Systems Corp., Tokyo, Japan) as the main support and the glass phosphor with the square pyramid array in two faces structure at the tip. The glass phosphor was attached to the tip of the hemostatic clip with an adhesion bond (Figure 3 ).
6
Submucosal Dissection with S-O Clip
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We use the S-O clip as needed, particularly when the submucosal layer is difficult to access during submucosal dissection. Indications for use of the S-O clip in our hospital are as follows: (1) existence of severe submucosal fibrosis, (2) tumor progression into the diverticula and the appendix, and (3) difficult accessibility of the submucosal layer for the scope. All seven operators equally applied the S-O clip.
After partial submucosal dissection of the tumor, the S-O clip was placed on the edge of the exfoliated mucosa. A nylon loop attached to the S-O clip was hooked to a normal or long clip (HX-610–135 or HX-610–090 L, Olympus). The spring tip (opposite side of the clip) was fixed at the opposite side of the lesion, at a distance of two folds behind the scope tip (
Fig. 2 ). Thereafter, visibility of the submucosal layer was increased, facilitating dissection. After ESD, the nylon loop was cut by the DualKnife J or ITknife nano, and the segment attached to the S-O clip was removed from the colon using a collection net (Olympus).
After partial submucosal dissection of the tumor, the S-O clip was placed on the edge of the exfoliated mucosa. A nylon loop attached to the S-O clip was hooked to a normal or long clip (HX-610–135 or HX-610–090 L, Olympus). The spring tip (opposite side of the clip) was fixed at the opposite side of the lesion, at a distance of two folds behind the scope tip (
7
Endoclip Placement Techniques for Diverticulum Closure
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We classified clipping methods into direct and indirect clipping. In the direct clipping method,
endoclips (HX-610-090S EZ CLIP; Olympus Optical Company Ltd.) were placed directly onto the
vessel (
Fig. 1a ,
Video 1 ). When direct placement of endoclips onto the vessel was not possible, the diverticulum was closed in a zipper manner (
Fig. 1b ). In the indirect clipping method, endoscopists selected the type of endoclips (HX-610-090S, HX-610-135, or HX-610-090 L, EZ CLIP; Olympus Optical Company Ltd.) based on the shape of the diverticulum (
Fig. 2 ). In the current study, we distinguished between direct and indirect clip placement using endoscopic reports and colonoscopic images.
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We classified clipping methods into direct and indirect clipping. In the direct clipping method,
endoclips (HX-610-090S EZ CLIP; Olympus Optical Company Ltd.) were placed directly onto the
vessel (
8
Management of Acute Lower GI Bleeding
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Patients with ALGIB underwent contrast‐enhanced CT whenever possible after medical examination and preliminary investigations.
Patients considered as having CDB underwent colonoscopy for diagnosis and treatment within 24 h of admission, with bowel preparation using polyethylene glycol. Hemodynamically unstable patients underwent colonoscopy without bowel preparation. Colonoscopy was performed with a water‐jet scope (PCF‐Q260AZI, PCF‐Q260JI, or PCF‐H290I; Olympus Medical Systems, Tokyo, Japan). A soft hood (D201‐12704; Olympus Medical Systems) was attached to the endoscope. Colonoscopy was performed by expert endoscopists (board‐certified members of the Japanese Society of Gastroenterology, having experience with > 1000 routine colonoscopies) or by nonexpert endoscopists under expert supervision.
The most commonly performed endoscopic treatment for CDB was EC, between April 2008 and May 2009, and EBL, performed between April 2009 and March 2018. Hemoclips (HX‐600‐090L, HX‐600‐135, HX‐610‐090L, or HX‐610‐135; Olympus Optical CO. Ltd, Tokyo, Japan) were used for EC. EBL was performed using a band‐ligator device (MD‐48710 EVL Device, Sumitomo Bakelite Co. Ltd, Tokyo, Japan).
Patients considered as having CDB underwent colonoscopy for diagnosis and treatment within 24 h of admission, with bowel preparation using polyethylene glycol. Hemodynamically unstable patients underwent colonoscopy without bowel preparation. Colonoscopy was performed with a water‐jet scope (PCF‐Q260AZI, PCF‐Q260JI, or PCF‐H290I; Olympus Medical Systems, Tokyo, Japan). A soft hood (D201‐12704; Olympus Medical Systems) was attached to the endoscope. Colonoscopy was performed by expert endoscopists (board‐certified members of the Japanese Society of Gastroenterology, having experience with > 1000 routine colonoscopies) or by nonexpert endoscopists under expert supervision.
The most commonly performed endoscopic treatment for CDB was EC, between April 2008 and May 2009, and EBL, performed between April 2009 and March 2018. Hemoclips (HX‐600‐090L, HX‐600‐135, HX‐610‐090L, or HX‐610‐135; Olympus Optical CO. Ltd, Tokyo, Japan) were used for EC. EBL was performed using a band‐ligator device (MD‐48710 EVL Device, Sumitomo Bakelite Co. Ltd, Tokyo, Japan).
9
Contrast CT and Colonoscopy for ALGIB
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All patients with ALGIB, except those with renal dysfunction or contrast medium allergy, underwent contrast-enhanced computed tomography (CT). For the remaining patients, the decision to perform plain CT was left to the physicians' discretion.
Colonoscopy was performed with a water-jet scope (PCF- Q260AZI, PCF-Q260JI, PCF-H290I, or GIF-Q260J; Olympus Medical Systems, Tokyo, Japan) with a soft hood (D201-12704; Olympus Medical Systems) attached after bowel preparation using polyethylene glycol, unless the patient was hemodynamically unstable. Colonoscopy was performed by expert or nonexpert endoscopists under supervision. Expert endoscopists were defined as institutional teaching staff of St. Luke's International Hospital who were also board-certified members of the Japanese Society of Gastroenterology and had performed more than 5,000 routine colonoscopies. Nonexpert endoscopists were not board-certified but had performed more than 500 routine colonoscopies before performing endoscopic hemostasis. The most frequently performed initial therapy for CDB was EC with Hemoclips (HX-600-090 L, HX-600-135, HX-610-090 L, or HX-610-135; Olympus Optical, Tokyo, Japan) from January 2008 to May 2009, and EBL with a band ligator device (MD-48710 EVL Device or MD-48912B EBL Device; Sumitomo Bakelite, Tokyo, Japan) from June 2009 to December 2019.
Colonoscopy was performed with a water-jet scope (PCF- Q260AZI, PCF-Q260JI, PCF-H290I, or GIF-Q260J; Olympus Medical Systems, Tokyo, Japan) with a soft hood (D201-12704; Olympus Medical Systems) attached after bowel preparation using polyethylene glycol, unless the patient was hemodynamically unstable. Colonoscopy was performed by expert or nonexpert endoscopists under supervision. Expert endoscopists were defined as institutional teaching staff of St. Luke's International Hospital who were also board-certified members of the Japanese Society of Gastroenterology and had performed more than 5,000 routine colonoscopies. Nonexpert endoscopists were not board-certified but had performed more than 500 routine colonoscopies before performing endoscopic hemostasis. The most frequently performed initial therapy for CDB was EC with Hemoclips (HX-600-090 L, HX-600-135, HX-610-090 L, or HX-610-135; Olympus Optical, Tokyo, Japan) from January 2008 to May 2009, and EBL with a band ligator device (MD-48710 EVL Device or MD-48912B EBL Device; Sumitomo Bakelite, Tokyo, Japan) from June 2009 to December 2019.
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