title: Gel immersion endoscopy: a novel method to secure the visual field during endoscopy in bleeding patients (with videos).
abstract: OBJECTIVE
  It is difficult to secure the visual field during endoscopy for GI bleeding or colonoscopy without preparation because the injected water is rapidly mixed with fresh blood or stool. We developed a novel method to secure the visual field in these situations.
  
  
  METHODS
  Clear gel with the appropriate viscosity to prevent rapid mixing is injected through the accessory channel, instead of water. A vinyl tube was used as an in vitro GI bleeding model. After filling the lumen with indigo carmine dye, air insufflation and water injection are not effective for securing the visual field. However, after gel injection, the bleeding source is observed clearly in the space occupied by the gel. The efficacy of this method was evaluated subjectively in clinical use. From February 2014 until June 2015, gel immersion was used in 17 consecutive patients when the visual field could not be secured with routine insufflation.
  
  
  RESULTS
  Of these 17 patients, gel injection was very effective in 10, effective in 5, slightly effective in 1, and not effective in 1. There were no adverse events associated with this method.
  
  
  CONCLUSIONS
  Gel immersion endoscopy is safe and effective for securing the visual field, creating a space for endoscopic visualization and treatment in otherwise difficult situations.
authors.affiliation: Division of Gastroenterology, Department of Medicine, Jichi Medical University, Tochigi, Japan.
authors.forename: Tomonori
authors.initials: T
authors.lastname: Yano
authors.affiliation: Division of Gastroenterology, Department of Medicine, Jichi Medical University, Tochigi, Japan.
authors.forename: Daiki
authors.initials: D
authors.lastname: Nemoto
authors.affiliation: Division of Gastroenterology, Department of Medicine, Jichi Medical University, Tochigi, Japan.
authors.forename: Kohei
authors.initials: K
authors.lastname: Ono
authors.affiliation: Division of Gastroenterology, Department of Medicine, Jichi Medical University, Tochigi, Japan.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Miyata
authors.affiliation: Division of Gastroenterology, Department of Medicine, Jichi Medical University, Tochigi, Japan.
authors.forename: Norikatsu
authors.initials: N
authors.lastname: Numao
authors.affiliation: Division of Gastroenterology, Department of Medicine, Jichi Medical University, Tochigi, Japan.
authors.forename: Chihiro
authors.initials: C
authors.lastname: Iwashita
authors.affiliation: Division of Gastroenterology, Department of Medicine, Jichi Medical University, Tochigi, Japan.
authors.forename: Manabu
authors.initials: M
authors.lastname: Nagayama
authors.affiliation: Division of Gastroenterology, Department of Medicine, Jichi Medical University, Tochigi, Japan.
authors.forename: Haruo
authors.initials: H
authors.lastname: Takahashi
authors.affiliation: Division of Gastroenterology, Department of Medicine, Jichi Medical University, Tochigi, Japan.
authors.forename: Alan K
authors.initials: AK
authors.lastname: Lefor
authors.affiliation: Division of Gastroenterology, Department of Medicine, Jichi Medical University, Tochigi, Japan.
authors.forename: Hironori
authors.initials: H
authors.lastname: Yamamoto
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004396:Coloring Agents; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000000981:diagnostic imaging* / Q000209:etiology; D005782:Gels; D006801:Humans; D007101:Immersion; D007203:Indigo Carmine; D007415:Intestinal Obstruction / Q000209:etiology*; D007579:Jejunal Diseases / Q000000981:diagnostic imaging*; D008297:Male; D008309:Mallory-Weiss Syndrome / Q000150:complications; D008875:Middle Aged; D012002:Rectal Diseases / Q000000981:diagnostic imaging*; D012811:Sigmoid Neoplasms / Q000150:complications*; D055815:Young Adult
chemical_list: D004396:Coloring Agents; D005782:Gels; D007203:Indigo Carmine