I need some help.

[halconmd]

Hi everyone. Im not sure if my questions are appropriate here. Im just doing a little research and i really need these information. Thanks.
1. What's the largest diameter that an esophageal sphincter can admit in a normal adult?

2. What's the diameter of the largest gastroscope you've ever had an experience using?

3. Can gastric mucosal suturing be performed thru a gastroscope/endoscope?

4. What are the usual complications for using a gastroscope too big for an esophageal sphincter aside from possible mucosal tearing and bleeding? Can this cause GERD?

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[halconmd]

Anybody?

 

[halconmd]

Is there anybody here who can shed light on my questions?http://img.studentdoctor.net/images/smilies/sleep.gif Can I lets say insert a rod about 2-3 cms in diameter through the esophageal sphincter? And if one of your patients accidentally swallowed a scalpel blade and you did your endoscopy and saw no other injuries from the mouth thru the esophagus even the esoph. sphincter except for a bleeding laceration thru the gastric mucosa until the submucosa and you know you can retrieve the scalpel blade without causing additional injuries and you're pretty sure that this patient needs just a single suture with a single bite. Can you perform endoscopic suturing? This forum's dead. lets give then all the GI cases and all the endoscopies to surgeons. they'll have a say on this. A Misterioso-type is what this forum needs.http://img.studentdoctor.net/images/smilies/thumbdown.gif

 

[halconmd]

Hi Blade28. Im just working on an idea Im trying to get a patent on. Id have to ask it this way to avoid having to reveal my "creation". Im still trying to decide up to what size i can make it for it to pass through the esophageal sphincter, and whether i can attach it to the gastric wall via endoscopic suturing to avoid having to do laparotomy. you didnt answer my questions but thanks for replying.

 

[core0]

Hi everyone. Im not sure if my questions are appropriate here. Im just doing a little research and i really need these information. Thanks.
1. What's the largest diameter that an esophageal sphincter can admit in a normal adult?

I'll take a swing at this I guess since no one else is answering. They pass a 9 to 11 cm endoscope pretty easily. Dilators go up to 60fr (20mm if I remember the conversion correctly. Usually the physicians I work with start a few Fr above the scope and go up a total of 6fr. I saw an plastic army soldier in a 4 years olds stomach so I would guess at least 20mm in a healthy person.

2. What's the diameter of the largest gastroscope you've ever had an experience using?

No experience. The largest scope that I have seen is a therapeutic scope which is around 13mm. Colonoscopes can be that big also. There are over tubes which are bigger. I have only seen them used a couple of times but they run around 15mm if I remember.

3. Can gastric mucosal suturing be performed thru a gastroscope/endoscope?

There is a suture device used in endoscopic fundoplication called an endocinch. http://www.endocinch.com/patient_index.cfm
However almost all mucosal damage will heal up in a few days so why would you need to do mucosal suturing? You could put a clip on a wound if you really felt like it but again why?

4. What are the usual complications for using a gastroscope too big for an esophageal sphincter aside from possible mucosal tearing and bleeding? Can this cause GERD?

You cannot cause GERD with an endoscope. In a healthy person there is not really such thing as too big an endoscope. If you have an LES stricture you may not be able to get the scope through. Trying to force it through may cause mucosal tearing and in the worse case scenario might cause esophageal perforation but this would be rare. Usually the scopes are around 8mm so it takes a pretty tight stricture for this to be a problem. You can try to balloon it blindly which is a little scary.

I saw your post below I am not sure why you would want to put a rod through the esophagus. As far as a scapel blade I am not sure. I have seen someone swallow boxcutter blades and those were pretty easy to get out. If you had something big like a 20 blade I guess you could pull it into a overtube and pull it out that way.

Just my thoughts. Don't scope, just watch when I have the time.

David Carpenter, PA-C

 

[gastrodoc]

Google "NDO plicator".
It's the largest thing I've passed into a patient via the OP. The hang up insn't at the LES, it's at the UES and hypopharynx. If the device is too big you can also get airway compromise.

You should also google NOTES(nat orifice surgery)- there is a ton of device development and research going on with this now.

Good luck with the patent.

 

[halconmd]

Thank you very much Gastrodoc and core0.