Gif 1th190

A variety of transgastric interventions were performed for suspected luminal and/or extraluminal pathology. The index transgastric intervention was performed either during the same session as EUS-GG creation (i. e., single-session EDGI) or in a subsequent session after EUS-GG creation (i. e., dual-session EDGI). Depending on the indication for EDGI, either a diagnostic gastroscope (GIF-HQ190; Olympus, Central Valley, Pennsylvania, United States), therapeutic gastroscope (GIF-1TH190; Olympus) and/or linear echoendoscope (GF-UCT180; Olympus) was passed through the LAMS, or through a mature GG/JG fistula immediately following LAMS removal, into the bypassed stomach. Fluoroscopy was used to help guide the scope in a parallel fashion through the LAMS to reduce risk of LAMS dislodgment. Transgastric EUS was performed in eight of 14 patients (57.1 %) using a 14.6-mm (outside diameter) therapeutic linear echoendoscope. In four cases, the therapeutic echoendoscope was passed through a mature GG/JG fistula immediately following LAMS removal (all dual-session EDGIs). In three cases, transgastric passage of the therapeutic echoendoscope occurred through an indwelling 20-mm LAMS (all dual-session EDGIs). In one case, transgastric passage of the therapeutic echoendoscope occurred through an indwelling 15-mm LAMS, after LAMS fixation (single-session EDGI).

Therapeutic channel (3.7 mm) endoscope (GIF-1TH190; Olympus, Tokyo, Japan), tapered transparent cap (DH-28GR; Fujifilm, Tokyo, Japan), bipolar device (Speedboat-RS2; Creo Medical Ltd, Chepstow, Wales, UK), endoscopic clips (EZ Clip, HX-610 – 090L; Olympus Corp.), and coagulation forceps (Coagrasper G, FD-412LR, Olympus, Japan) were used.

After resuscitation, we performed the procedures under conscious or deep sedation using midazolam and fentanyl, depending on the clinical situation. We used a therapeutic upper endoscope (GIF 1TQ160, GIF 1TH190, or GIF 1XTQ160, Olympus Corp, Japan) equipped with water jet function and attached a distal cap (Olympus Corp, Japan) when required. After suctioning blood and identifying the source of bleeding, we equipped the scope with a medium-sized (12-mm) atraumatic OTSC device and clamped the bleeding vessel.
The technique of OTSC application is similar to that of endoscopic variceal ligation. We positioned the OTSC cap such that the bleeding lesion was located inside the perimeter of the cap. Upon achieving a satisfactory position, we applied suction and securely placed the clip deep below the vessel (
Fig. 1). In fibrotic ulcers, we used the OTSC anchor to hook the ulcer base and, while applying full suction, pull it inside the cap before clipping.