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World J Gastroenterol. Jan 28, 2025; 31(4): 101288
Published online Jan 28, 2025. doi: 10.3748/wjg.v31.i4.101288
Gel immersion in endoscopy: Exploring potential applications
Hiroki Sato, Hidemasa Kawabata, Mikihiro Fujiya
Hiroki Sato, Hidemasa Kawabata, Mikihiro Fujiya, Department of Internal Medicine, Asahikawa Medical University, Asahikawa 078-8510, Hokkaido, Japan
Co-corresponding authors: Hiroki Sato and Mikihiro Fujiya.
Author contributions: Sato H and Kawabata H authored the introduction section and the section on the effect of gel through the adaptation of other gels; Sato H and Kawabata H also conducted a literature search for the section on the methods of utilizing gel immersion in digestive endoscopy; Sato H and Fujiya M reviewed literature related to the esophagus, stomach, duodenum and small intestine, and colon and rectum sections and the methods of utilizing gel immersion in digestive endoscopy section; Sato H and Fujiya M drafted these sections and created the associated tables (Tables 1, 2, 3, and 4); Sato H and Kawabata H reviewed literature related to the hepatobiliary and pancreas section, authored the relevant sections, and created the accompanying tables (Table 5); the future perspectives on gel immersion endoscopy and conclusion sections were written by Sato H, Kawabata H, and Fujiya M, based on collected literature; Sato H created Figure 1; Kawabata H created Figures 2 and 3; Sato H and Fujiya M performed a final review of all sections, coordinating necessary revisions with the respective co-authors of each section; This review article spans both the gastrointestinal and hepatobiliary-pancreatic fields. It was supervised by experts in each respective area: Fujiya M for the gastrointestinal field and Sato H for the hepatobiliary and pancreas field. This collaboration was essential to create a comprehensive, cross-organ review article.
Supported by the Japan Society for the Promotion of Science KAKENHI, No. 21KK0283 (to Sato H).
Conflict-of-interest statement: Mikihiro Fujiya: Others, OLYNPUS Co., Ltd., Boston Scientific Corporation, FUJIFILM Corporation, Otsuka Pharmaceutical Co., Ltd. There are no conflicts of interest associated with the authors who contributed to this manuscript.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hiroki Sato, MD, PhD, Academic Fellow, Postdoctoral Fellow, Research Associate, Department of Internal Medicine, Asahikawa Medical University, 1-1, Midorigaoka Higashi 2 Jyo 1 Chome, Asahikawa 078-8510, Hokkaido, Japan. hirokisato@asahikawa-med.ac.jp
Received: September 10, 2024
Revised: November 19, 2024
Accepted: December 6, 2024
Published online: January 28, 2025
Processing time: 111 Days and 4.8 Hours
Abstract

The challenge of effectively eliminating air during gastrointestinal endoscopy using ultrasound techniques is apparent. This difficulty arises from the intricacies of removing concealed air within the folds of the gastrointestinal tract, resulting in artifacts and compromised visualization. In addition, the overlap of folds with lesions can obscure their depth and size, presenting challenges for an accurate assessment. Conversely, in intricately folded regions of the gastrointestinal tract, such as the stomach, intestine, and colon, insufficient delivery of air or CO2 into the cavity impedes luminal expansion, hindering the accurate visualization of lesions concealed within the folds. Although this underscores the requirement for substantial airflow, excessive airflow can hinder visualization of bleeding lesions and other abnormalities. Considering these challenges, an ideal endoscopic device would facilitate the observation of lesions without the requirement for air or CO2 delivery whereas, ensuring optimal expansion of the gastrointestinal tract. Recently, transparent gels with specific viscosities have been employed more frequently to address this issue. This review aims to elucidate how these gels address these challenges and provide a solution for enhanced endoscopic visualization.

Keywords: Gel immersion; Endoscopy; Endoscopic visualization; Gastrointestinal endoscopy; Endoscopic ultrasonography

Core Tip: This review examines the challenges associated with gastrointestinal endoscopy, particularly the difficulty of eliminating air during ultrasound techniques, which results in artifacts and reduced visualization quality. Insufficient or excessive airflow can impede accurate assessment of lesions within the gastrointestinal folds. This review highlights the use of transparent viscous gels to facilitate improved endoscopic visualization without requiring air or CO2 delivery, thereby enhancing lesion observation accuracy in complex regions of the gastrointestinal tract.