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Reduction of acute gastric volvulus in a 3-year-old using a balloon-attached endoscope combined with gel immersion endoscopy

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Abstract

When performing endoscopic reduction in patients with gastric volvulus, it is important to maintain a low level of intragastric pressure and to fix the endoscope in the duodenum. Gel immersion endoscopy is a new method for securing the visual field by injecting clear gel. The balloon-attached endoscope makes it easier to fix the tip in the duodenum without mucosal damage. We report successful reduction of a mesenteroaxial gastric volvulus using an endoscope with a balloon in combination with gel immersion endoscopy. A 3-year-old Japanese male developed gastric volvulus. Since gastric decompression using a nasogastric tube failed to reduce the volvulus, endoscopic reduction was performed under general anesthesia. After aspiration of intragastric gas, clear gel was injected through the accessory channel which secured the visual field in the stomach even with residue while maintaining low intragastric pressure. After reaching the descending portion of the duodenum, the balloon attached to the tip of the endoscope was inflated and fixed in the duodenum. The volvulus was successfully reduced by pulling back the endoscope with clockwise torque. Acute mesenteroaxial gastric volvulus has the potential to cause ischemia and perforation which can be life-threatening, so most patients are treated with surgical intervention. Gel immersion endoscopy is safe and effective to secure the visual field, even in children. Endoscopic reduction may be a viable treatment option for reducing gastric volvulus in non-emergent patients.

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Authors and Affiliations

  1. Department of Pediatrics, Jichi Medical University, Shimotsuke, Tochigi, Japan

    Koji Yokoyama, Hideki Kumagai, Yuko Okada, Yusuke Hashimoto & Takanori Yamagata

  2. Department of Internal Medicine, Division of Gastroenterology, Jichi Medical University, Shimotsuke, Tochigi, Japan

    Tomonori Yano

  3. Department of Pediatric Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan

    Shigeru Ono

  4. Department of Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan

    Alan Kawarai Lefor

Authors
  1. Koji Yokoyama
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  2. Tomonori Yano
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  3. Hideki Kumagai
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  4. Yuko Okada
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  5. Yusuke Hashimoto
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  6. Shigeru Ono
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  7. Alan Kawarai Lefor
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  8. Takanori Yamagata
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by KY, TY and HK. The first draft of the manuscript was written by KY and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Koji Yokoyama.

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Conflict of interest

Tomonori Yano has a patent for the dedicated gel for gel immersion method and belongs to the Department of Endoscopic Research and International Education (Funded by FUJIFILM Medical and FUJIFILM) and have received honoraria and grants from these corporations. None of the other authors declare no conflicts of interest in association with the present study.

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All procedures followed were performed in accordance with the ethical standards in the 1964 Declaration of Helsinki and its later amendments.

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Informed consent was obtained from the patient and his mother for inclusion in this study.

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Yokoyama, K., Yano, T., Kumagai, H. et al. Reduction of acute gastric volvulus in a 3-year-old using a balloon-attached endoscope combined with gel immersion endoscopy. Clin J Gastroenterol 15, 95–100 (2022). https://doi.org/10.1007/s12328-021-01566-5

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  • DOI: https://doi.org/10.1007/s12328-021-01566-5

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