Points to Consider About Preparation

It should be noted that two selector switches not lighting up on the controller indicate an exhaust mode (air is being withdrawn from the balloon) when the power of the balloon pump controller is turned on. In particular, if the endoscope tip is immersed in water while the scope selector switch indicates an exhaust mode, water is aspirated into the air route of the endoscope, which may block the air route. Caution should be exercised to avoid accidental water aspiration when the endoscope is withdrawn from the overtube after completing the examination. Air should be delivered whenever the endoscope tip without a balloon is immersed in water.

The balloon controller is designed to activate an alarm when abnormal balloon pressure occurs. Specifically, an alarm sounds when the air supply continues without a change in balloon pressure (if a pressure of 5.6 kPa is not achieved within 60 s of air supply or an air route pressure of 5.6 kPa is not maintained for 40 s or more during air supply) or when there is an abnormal increase in the balloon pressure (the air route pressure is 8.2 kPa or above for 5 s or more). It is desirable to press the pause switch or turn off the power of the balloon pump controller when a balloon is not firmly attached to the scope during preparation and air supply or withdrawal is not necessary. It is particularly advisable to take these precautions until you familiarize yourself with preparation procedures.

If the endoscope is removed while leaving the overtube in the intestinal tract for a certain treatment, a fixing rubber should not be used to secure the endoscope balloon (fixing rubber may stick to the overtube, which prevents removal of the endoscope). In this case, both the distal and proximal end of the endoscope balloon should be secured with nylon thread (Fig. 7.14). In principle, a hood should not be attached to the endoscope in this situation. When a hood is absolutely necessary at the time of endoscope insertion, it should be noted that the hood must be left in the intestinal tract at the time the endoscope is removed. The hood may be collected endoscopically at the end of the treatment, or it may be excreted in the feces.

Fig. 7.14. Secure the endoscope balloon with thread. Secure the balloon at four sites. The second ligature from the tip should be placed distal to the opening of the air route. Without the second ligature, a deflated endoscope balloon may interfere with the field of view during examination

The distal end of the double-balloon endoscope has grooves where the endoscope balloon is secured with thread. Practically, two fixing rubbers are sufficient to secure the balloon, as described above; however, these grooves may be used to secure the balloon, and the following step should be taken between procedures (9) and (10).

Either nylon fishing line (approximately 0.145 mm in diameter, equivalent to no. 0.8) or nylon surgical sutures (3-0 or 4-0) are used to tie the endoscope balloon and the distal end of the endoscope together at the sites of the grooves (Figs. 7.15, 7.16).

Fig. 7.15. Groove at the distal end of the endo- Fig. 7.16. Secure the distal end of the endoscope scope balloon with nylon thread

We tentatively make a knot as shown in Fig. 7.17, pass the endoscope through the knot as indicated with a star, and then tighten the knot by pulling on both ends. After making another knot, we wind the rest of the line around the endoscope and tie it again.

Fig. 7.17. Example of a tentative knot in nylon thread

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