Two-Endoscope EMR Technique for Esophageal Lesions
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Solution Overview
Problem
Current endoscopic mucosal resection (EMR) techniques face complications such as bleeding and perforation due to the use of specially designed, expensive endoscopes with limited availability and require specialized training, and existing methods compromise visualization and procedural efficiency.
Innovation Solution
A two-endoscope technique using a standard uncapped endoscope for chromoendoscopy, injection, snaring, and specimen recovery, and a capped endoscope for suction and ligation, allowing for minimally invasive procedures without the need for specialized equipment or extensive training, thereby reducing the risk of bleeding and perforation.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Adaptability or versatility
If a single specially designed endoscope with cap is used for EMR, then the procedure can be performed with integrated functions, but the device complexity increases and availability decreases
Solution Approach 1:
The EMR procedure is divided into distinct functional stages: chromoendoscopy and injection using a standard uncapped endoscope, followed by suction and ligation using a capped endoscope. This segmentation allows each endoscope to perform its specific function optimally without requiring a complex integrated design, thereby reducing device complexity while maintaining procedural versatility.
2Reliability
If a specially designed endoscope for EMR is used, then the procedure can be performed, but the cost increases and availability decreases
Solution Approach 1:
The invention utilizes standard endoscopes that are already widely available and familiar to endoscopists, rather than requiring specialized EMR-designed endoscopes. By making the procedure compatible with existing universal equipment, the cost and availability barriers are removed while maintaining reliable EMR capability through the two-endoscope technique.
3Ease of operation
If a cap is affixed to the endoscope for EMR, then suction and ligation can be performed, but the visualization is compromised
Solution Approach 1:
The procedure is segmented so that chromoendoscopy and injection are performed with an uncapped endoscope providing clear visualization, while suction and ligation are performed with a capped endoscope. This temporal and functional segmentation allows each step to be performed with optimal visualization conditions, avoiding the compromise of continuous cap presence.
4Ease of operation
If submucosal injection is used to lift the lesion, then the mucosa can be elevated for resection, but the needle positioning becomes difficult within the confined cap space
Solution Approach 1:
Submucosal injection is performed as a preliminary action before cap attachment and ligation. By completing the injection step with the uncapped endoscope first, the mucosa is elevated in advance, avoiding the difficulty of needle positioning within the confined cap space during the ligation phase.
Applied Scientific Principles
This section explains which scientific principles are used to turn an abstract innovation direction into a practical engineering solution.
Function Achieved in This Case
This method simplifies EMR procedures, reduces complications by maintaining clear visualization and avoiding the confinement issues of single, specially designed caps, making the technique accessible to more endoscopists and applicable to various gastrointestinal lesions, including Barrett's esophagus and gastric antral intestinal metaplasia.
Implementation Method 1
Chromoendoscopy using an appropriate staining dye, such as methylene blue, is used to identify the mucosa with intestinal metaplasia, a lesion. 0.5% methylene blue is sprayed through a cannula onto the mucosa at least around the area of a lesion.
Implementation Method 2
Cap-assisted EMR typically uses submucosal injection to lift the target lesion at the mucosa.
Implementation Method 3
The endoscope is then positioned immediately over the target lesion, suction is used to retract the mucosa into the cap
Implementation Method 4
The cap is usually equipped with a specially designed, crescent-shaped electrocautery snare that is opened and positioned on an internal circumferential ridge at the tip of the cap.
Data Source
AI summary
For Endoscopic Mucosal Resection (EMR), particularly for the esophagus and stomach, a kit includes two endoscopes that are used alternatingly to separate chromoendoscopy for staining of intestinal metaplastic mucosa, injecting solution to raise diseased mucosa, snare polypectomy, and wound clipping from cap-assisted suction and ligation of the mucosa, for making these procedures more focused and readily accomplished, with less likelihood of bleeding and perforation.