Cap-fitted gastroscopy improves visualization and targeting of lesions

Difficulty with visualization and targeting of lesions to obtain biopsy specimens or for endoscopic treatment during diagnostic and therapeutic EGD may be due to a tangential approach, endoscope tip instability, or close proximity to the lesion resulting in a "red-out." Cap-fitted EGD (CF-EGD) adds a "tactile" dimension and enhances visualization and targeting of lesions by allowing manipulation of tangential sites to a more "en-face" approach, thereby improving tip stability and maintaining close apposition to the lesion without losing the endoscopic view.

A recycled transparent cap from a multiband variceal ligator was evaluated during EGD. Where lesions were deemed to be suboptimally visualized or targeted, CF-EGD was performed during the same procedure. Nineteen patients had CF-EGD after conventional EGD.

Lesions were located in the duodenal bulb (7), apex of the bulb (5), descending duodenum (1), pylorus (1), posterior gastric wall (3), incisura (1), cardia (1), and afferent limb (Billroth II) (2). Diagnoses were duodenal ulcer (7), duodenal varix (1), gastric metaplasia (1), duodenal Crohn's disease (1), duodenal polyp (3), gastric ulcer (3), antral cancer (1), gastric polyp (1), and anastomotic ulcer (2). Targeted biopsy specimens were obtained in 7, bleeding ulcers treated in 4 (3 duodenal ulcer, 1 anastomotic), and a duodenal polyp (2.5 cm diameter) was removed in 1.

This adaptation of a recycled transparent cap is simple, safe, and effective and improves visualization and targeting of lesions.