Ustündağ Yücel, Saritaş Ulkü, Ponchon Thierry
Department of Gastroenterology, Zonguldak Karaelmas University School of Medicine, Zonguldak, Turkey.
Turk J Gastroenterol. 2011 Jun;22(3):237-42. doi: 10.4318/tjg.2011.0207.
Small caliber endoscopes are one of the best examples of fantastic technological advancements in gastrointestinal endoscopy. First designed for pediatric patients in the 1970s, current small caliber videoendoscopes were used for unsedated transnasal gastrointestinal endoscopy after 1994. Nowadays, unsedated endoscopy can be successfully done using small caliber endoscopes via transoral or transnasal route in nearly 90% of cases. Several large studies have shown that small caliber endoscopy is feasible, safe and well-tolerated. These devices can decrease the potential risks of upper gastrointestinal endoscopy by eliminating the need for sedation since these ultrathin endoscopes induce much less gag reflex or choking sensation in patients. Moreover, gastrointestinal endoscopy with small caliber endoscopes results in less sympathetic system activation as well as less oxygen desaturation compared to standard endoscopy, especially in aged, severely ill, bedridden patients. Nevertheless, there is no overall consensus on its cost effectiveness. Though indications are similar with standard endoscopy, small caliber endoscopy can be preferred in patients with gastrointestinal stenosis. Less common indications include transnasal endoscopic retrograde cholangiography and postpyloric feeding tube insertion. The esophagogastroduodenoscopy procedure with small caliber endoscopes is easy to perform, and there is generally no need for further training for this technique. However, the additional cost of equipment and some medicolegal and technical issues have resulted in the unpopularity of small caliber endoscopy in most countries other than France and Japan. However, sharing information about this technique and stressing its potential advantages can help in its widespread use in various countries including Turkey. We believe that routine use of small caliber endoscopes during daily gastrointestinal endoscopy practice is not far away in many countries.
小口径内镜是胃肠内镜领域令人惊叹的技术进步的最佳范例之一。小口径视频内镜最初于20世纪70年代为儿科患者设计，1994年后用于非镇静经鼻胃肠内镜检查。如今，近90%的病例可以通过经口或经鼻途径使用小口径内镜成功完成非镇静内镜检查。多项大型研究表明，小口径内镜检查是可行、安全且耐受性良好的。这些设备通过消除镇静的需要，降低了上消化道内镜检查的潜在风险，因为这些超薄内镜在患者中引起的 gag 反射或窒息感要小得多。此外，与标准内镜检查相比，使用小口径内镜进行胃肠内镜检查导致交感神经系统激活减少以及氧饱和度降低减少，尤其是在老年、重症、卧床患者中。然而，关于其成本效益尚无总体共识。虽然适应证与标准内镜检查相似，但小口径内镜检查在胃肠狭窄患者中可能更受青睐。较少见的适应证包括经鼻内镜逆行胆管造影和幽门后喂食管插入。使用小口径内镜进行食管胃十二指肠镜检查操作简便，一般无需对该技术进行进一步培训。然而，设备的额外成本以及一些法医学和技术问题导致小口径内镜检查在法国和日本以外的大多数国家不受欢迎。然而，分享有关该技术的信息并强调其潜在优势有助于其在包括土耳其在内的各个国家广泛应用。我们相信，在许多国家，日常胃肠内镜检查实践中常规使用小口径内镜已为期不远。
