The wide-channel endoscope optimizes the success of emergency endoscopy

Success of emergency endoscopy in upper GI-hemorrhage for diagnostics and treatment is limited by masses of blood clots, food or both. Using standard endoscopes supported by adjuvant techniques bleeding source can be defined in 90 to 95%. These procedures are often time consuming. Only bleeding sources which are defined can be treated. This is difficult in cases of ongoing hemorrhage. Circulatory shock may occur as well as aspiration of gastric contents. For these reasons we developed the new wide-channel endoscope.

This endoscope (GIF-XT-30, Olympus, 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 connected to the 6 mm channel.

We achieved complete evacuation of stomach contents in 122 of 123 patients (= 23% of all emergency patients in this series) with upper GI-bleeding, in whom complete gastric cleaning and identification of the bleeding source had proved impossible using standard endoscopes. Gastric emptying using the big channel endoscope was possible within 5 minutes in all successful cases. Optimal conditions for therapeutic procedures were therefore provided.

The possibilities of this instrument enable a more aggressive technique of moving fixed coagula from ulcers to localize the vessel that is to be treated. Even in cases of provoked severe Forrest I A hemorrhage permanent visual control can be achieved. It is an indispensable tool for major endoscopic centers in emergency situations.