Optimization of insufflation and pressure control in third-space endoscopy.

Area of Science:

• Gastroenterology
• Endoscopic Surgery
• Medical Device Engineering

Background:

• Third-space endoscopy necessitates precise insufflation for visualization and workspace maintenance.
• Optimal insufflation parameters for third-space endoscopy remain undetermined.
• This study investigates endoluminal pressure variations and insufflation setting performance.

Purpose of the Study:

• To assess endoluminal third-space pressure diversity during manual insufflation.
• To evaluate the performance of insufflation settings in third-space endoscopy.

Main Methods:

• Submucosal tunnels were created in porcine stomachs for two-channel esophagogastroduodenoscopy.
• Experiment 1: Measured endoluminal pressure in a 10-cm tunnel with six endoscopists under manual insufflation.
• Experiment 2: Assessed pressure and insufflation frequency using a pressure-regulated device, comparing tunnel lengths and insufflation route diameters.

Main Results:

• Endoluminal submucosal tunnel pressure profiles varied significantly among endoscopists in Experiment 1.
• Longer tunnels and larger insufflation routes resulted in stable endoluminal pressure in Experiment 2.
• Increased tunnel length and route diameter reduced the discrepancy between preset and endoluminal pressure and decreased insufflation frequency.

Conclusions:

• Pressure dynamics in third-space endoscopy are variable among endoscopists.
• Longer submucosal tunnels and larger insufflation route diameters promote stable endoluminal pressure.