selves home or to work as soon as it ends."
It's a great concept, at least in theory. Douglas Adler, MD, FACG,
AGAF, FASGE, says more practical applications of ultrathin scopes
involve maneuvering around complex strictures and post-surgical
anatomy in upper GI tracts or use in pediatric patients who can't toler-
ate an adult scope.
Dr. Adler, a professor of medicine at the University of Utah School
of Medicine and Huntsman Cancer Center in Salt Lake City, believes
the primary benefit of ultrathin scopes is that they can be used in
office-based settings. "But very few gastroenterologists perform office-
based endoscopy procedures because they're used to performing a
complete upper examination, which includes the esophagus, stomach
and the beginning segment of the small bowel," he says.
Most in-office sedationless exams include the esophagus and perhaps
the beginning portion of the stomach due to patient tolerance, accord-
ing to Dr. Adler. "Culturally, physicians feel like esophageal screening
procedures are incomplete exams," he says. "What if they miss a stom-
ach ulcer they would have seen with a standard endoscope?"
Plenty of applications
Dr. Kaul says ultrathin endoscopes are ideally suited for performing
exams in patients with narrowing at the upper esophageal sphincter
and the gastroesophageal junction, and in the pylorus and duodenum.
"That's where these devices are most helpful," he explains. "They let
physicians complete examinations that would not be possible using
standard endoscopes."
Physicians who run into difficulty moving a colonoscope through
narrow areas of the colon often opt for a standard gastroscope, which
has a smaller diameter and the rigidity needed to maneuver through
the colon. Dr. Kaul says ultrathin endoscopes, which are too narrow
and too flexible, are not typically used during colonoscopy exams.
Ultrathin scopes can prove useful in facilitating stenting for col-
orectal malignancies in the lower GI tract, however. "Physicians who
need to access a tumor beyond a narrowing of the tract during a
colonoscopy, but are unsure of where to place the guidewire, can
remove the colonoscope and insert an ultrathin gastroscope, enter the
O C T O B E R 2 0 2 0
• O U T P A T I E N T S U R G E R Y . N E T • 4 1
Enhanced imaging helps physicians
identify lesions, better characterize
the mucosal lining and facilitate mapping
of abnormal anatomy.
— Vivek Kaul, MD, FACG, FASGE, AGAF
