Mota Fernando Lander, Centeno Deborah Marques, de Oliveira Fernando J S, Pereira Eduardo M A, Jacinto Sarah Madeira, Cardoso Pedro H A F, Armellini Savério T N, D'Assuncao Marco Aurélio
Department of Digestive Endoscopy, Hospital Sírio-Libanês, São Paulo, Brazil.
VideoGIE. 2021 Sep 8;6(11):518-521. doi: 10.1016/j.vgie.2021.07.005. eCollection 2021 Nov.
Upper GI bleeding (UGIB) is a medical emergency associated with elevated mortality and significant costs to the health care system. EGD is currently the method of choice for the diagnosis and management of these conditions. However, the location of bleeding lesions and technical difficulties in achieving endoscope stability may challenge even the most experienced endoscopists. Herein, we demonstrate the use of the cap and underwater technique as a helpful aid in these situations.
We present a case series of 4 patients with acute UGIB who underwent EGD with suboptimal endoscopic visualization or technical difficulties in identifying the source of bleeding. A transparent plastic cap was attached to the distal tip of the gastroscope, and the water immersion technique (underwater) was used for endoscopic re-evaluation of the bleeding site.
Three patients presented with duodenal bleeding, and 1 was diagnosed with diffuse bleeding from the esophagus. The clear and accurate identification of the source of bleeding and effective hemostasis were possible after cap and underwater technique evaluation in all patients.
The use of the cap and underwater technique is a simple, safe, and low-cost strategy that improves the identification and control of UGIB in locations with poor visibility and technical challenges during endoscopic evaluation.
上消化道出血（UGIB）是一种医疗急症，与死亡率升高及医疗系统的高额成本相关。内镜检查（EGD）目前是诊断和处理这些病症的首选方法。然而，出血病变的位置以及实现内镜稳定性的技术难题，即便对最有经验的内镜医师而言也可能构成挑战。在此，我们展示了使用透明帽和水下技术在这些情况下作为一种辅助手段的作用。
我们呈现了一组4例急性UGIB患者的病例系列，这些患者接受EGD时内镜视野欠佳或在确定出血源方面存在技术困难。在胃镜远端装上一个透明塑料帽，并采用水浸技术（水下）对出血部位进行内镜重新评估。
3例患者表现为十二指肠出血，1例被诊断为食管弥漫性出血。在所有患者中，经透明帽和水下技术评估后，均能够清晰准确地确定出血源并实现有效止血。
使用透明帽和水下技术是一种简单、安全且低成本的策略，可在内镜评估过程中改善对视野不佳及存在技术挑战部位的UGIB的识别与控制。
