THE WIDE-CHANNEL ENDOSCOPE OPTIMIZES THE SUCCESS OF EMERGENCY ENDOSCOPY

Introduction : Success of emergency endoscopy in upper GI-hemorrhage f or diagnostics and treatment is limited by masses of blood clots, food or both, Using standard endoscopes supported by adjuvant techniques b leeding source can be defined in 90 to 95%. These procedures are often time consuming. Only bleeding sources which are defined can be treate d. This is difficult in cases of ongoing hemorrhage. Circulatory shock may occur as well as aspiration of gastric contents. For these reason s we developed the new wide-channel endoscope. Methods : This endoscop e (GIF-XT-30, Olympus(R), Tokyo) has two channels, one with a diameter of 6 mm and a jet channel with 1 mm. The outer diameter at the distal end is 13.7 mm. A three-way stopcock for suction and water input is c onnected to the 6 mm channel. Results : We achieved complete evacuatio n of stomach contents in 122 of 123 patients (= 23% of all emergency p atients in this series) with upper GI-bleeding, in whom complete gastr ic cleaning and identification of the bleeding source had proved impos sible using standard endoscopes. Gastric emptying using the big channe l endoscope was possible within 5 minutes in all successful cases. Opt imal conditions for therapeutic procedures were therefore provided. Co nclusions : The possibilities of this instrument enable a more aggress ive technique of moving fixed coagula from ulcers to localize the vess el that is to be treated. Even in cases of provoked severe Forrest I A hemorrhage permanent visual control can be achieved. It is an indispe nsable tool for major endoscopic centers in emergency situations.