Korean Journal of Gastrointestinal Endoscopy 1995;15(4): 659-663.
원저 : 식도 위장관 ; 내시경적 식도정맥류 결찰술 시행시 안전하고도 간편한 Overtube 삽입법 ( Original Articles : Esophagus , Stomach & Intestine ; A Novel Method for Overtube Placement in Endoscopic Variceal Ligation )
윤용범, 송인성, 김정룡, 정현채, 이효석, 최규완, 한철주 (Yong Bum Yoon, In Sung Song, Chung Yong Kim, Hyun Chae Jung, Hyo Suk Lee, Kyu Wan Choi and Chul Ju Han)
Abstract
Endoscopic variceal ligation (EVL) is effective for the management of bleeding esophageal varices, and its use is widespread now. EVL necessitates the use of overtubes. Two primary techniques have been used for overtube placement; one is with endoscope, and the other is with bougie dilator. Overtube placement with endoseope is not without risk. There are reportd of esophageal or pharyngeal laceration or perforation. Overtube placement with bougie dilator circumvents this risk, but it is rather cumbersome to use. The authors devised a safe and easy method for overtube placement, and applied it to a number of patients to test its safety and convenience. First, overtube-dilator assembly was prepared as follows. A Rigiflex achalasia dilator (balloon 30mm OD, 10cm length; Microvasive Co) was lubricated and inserted into the overtube. A tenth of the balloon tip was protruded out of the overtube, then the balloon was insufflated with air at 10-15 psi. Second, standard endoscopy was performed, followed by placement of guide wire in the stomach. Overtube-dilator assembly was lubricated and introduced over the wire as a rail. Once the overtube was properly positioned, the balloon was deflated, and the balloon and wire were removed as a whole, which completed overtube placement. For 65 patients with esophageal variceal bleeding, 82 procedures of EVL were performed using the new technique. Overtube-dilator assembly was easy to prepare and handle. This technique added little time to the procedure and minimizes patients discomfort. No patient suffered major complications such as bleeding, laceration or perforation. This novel method for overtube placement was safe and convenient for use in EVL. It can also be applied to other procedures using overtube such as endoscopic foreign body removal. (Kor J Gastrointest Endosc 15: 659-663, 1995)
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