Clinical utility of ultrathin endoscopy in adult patients

BACKGROUND: Accurate diagnosis of gastrointestinal pathology and effective use of appropriate therapeutic modalities is the goal of every endoscopic procedure. Failure may be due to variations in anatomy, comorbid conditions and patient discomfort. Small caliber fiberoptic endoscopes (7.5 - 8.0 mm diameter), originally designed for the pediatric age group, have been used in adults for a number of years Recently, an ultrathin (53 mm diameter) fiberoptic endoscope (UT) has been developed and we report our experience with this instrument in an adult gastroenterology clinical practice. METHODS: A fiberoptic endoscope (Olympus N30) with a diameter of 5.3 mm, a biopsy channel of 2 mm, a working length of 925 mm, and an up/down and left/right tip deflection of 180 and 160 degrees respectively, was used. The decision to use the UT, either primarily or after a failed attempt with a standard endoscope, was at the discretion of the attending endoscopist. RESULTS: Eighty-four procedures were performed in 60 adult patients. The study group included 33 males and 27 females with a mean age of 59.4 years (range 25-91). Eighty-two of 84 procedures were performed perorally. One procedure was performed transnasally and one transmaxillary. The UT was used as the initial instrument in 56 of 84 procedures. The reasons included tight esophageal stricture (30), need to avoid sedation (18), poor patient tolerance (5) and trismus (3) The UT was used after failure of a standard endoscope in 28 procedures due to tight esophageal stricture (19), inability to intubate (4), poor patient tolerance (3), miscellaneous (2) The success rate of the procedure using the UT was 82 of 84 (98%). The duodenum was reached in 64 of 71 (90%) attempts. There were no complications. No sedation was used in 18 cases; in 10 due to medical contraindication and 8 at the patients' request. Patient tolerance was good in 80 of 84 (95%) procedures. Interventions performed with the UT included Savary guidewire dilation (38), PEG placement (8), forceps biopsy (5), submucosal contrast injection to aid esophageal stent placement (4), and laser therapy (1). Optical quality was adequate to achieve the goal of most procedures CONCLUSIONS: 1. The UT allow s performance of complete upper endoscopy in cases in which patient anatomy, comorbidity or tolerance limit the use of standard endoscopes. 2. Most endoscopic interventions and therapeutic procedures are possible with this instrument. 3. Patient discomfort and sedation can be minimized and/or avoided. 4. UT can be used in non-oral sites including transnasal, transmaxillary, trans-stoma and trans-gastrostomy tracts.