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Surgical Endoscopy

, Volume 31, Issue 10, pp 3946–3951 | Cite as

Stray energy transfer during endoscopy

  • Edward L. JonesEmail author
  • Amin Madani
  • Douglas M. Overbey
  • Asimina Kiourti
  • Satheesh Bojja-Venkatakrishnan
  • Dean J. Mikami
  • Jeffrey W. Hazey
  • Todd R. Arcomano
  • Thomas N. Robinson
Article

Abstract

Introduction

Endoscopy is the standard tool for the evaluation and treatment of gastrointestinal disorders. While the risk of complication is low, the use of energy devices can increase complications by 100-fold. The mechanism of increased injury and presence of stray energy is unknown. The purpose of the study was to determine if stray energy transfer occurs during endoscopy and if so, to define strategies to minimize the risk of energy complications.

Methods and Procedures

A gastroscope was introduced into the stomach of an anesthetized pig. A monopolar generator delivered energy for 5 s to a snare without contacting tissue or the endoscope itself. The endoscope tip orientation, energy device type, power level, energy mode, and generator type were varied to mimic in vivo use. The primary outcome (stray current) was quantified as the change in tissue temperature (°C) from baseline at the tissue closest to the tip of the endoscope. Data were reported as mean ± standard deviation.

Results

Using the 60 W coag mode while changing the orientation of the endoscope tip, tissue temperature increased by 12.1 ± 3.5 °C nearest the camera lens (p < 0.001 vs. all others), 2.1 ± 0.8 °C nearest the light lens, and 1.7 ± 0.4 °C nearest the working channel. Measuring temperature at the camera lens, reducing power to 30 W (9.5 ± 0.8 °C) and 15 W (8.0 ± 0.8 °C) decreased stray energy transfer (p = 0.04 and p = 0.002, respectively) as did utilizing the low-voltage cut mode (6.6 ± 0.5 °C, p < 0.001). An impedance-monitoring generator significantly decreased the energy transfer compared to a standard generator (1.5 ± 3.5 °C vs. 9.5 ± 0.8 °C, p < 0.001).

Conclusion

Stray energy is transferred within the endoscope during the activation of common energy devices. This could result in post-polypectomy syndrome, bleeding, or perforation outside of the endoscopist’s view. Decreasing the power, utilizing low-voltage modes and/or an impedance-monitoring generator can decrease the risk of complication.

Keywords

Endoscopy Stray energy Complication Coupling Polypectomy Impedance 

Notes

Acknowledgements

This research was supported by a grant from the Society of American Gastrointestinal and Endoscopic Surgeons (2016).

Compliance with ethical standards

Disclosures

Edward L. Jones MD, Amin Madani MD PhD, Douglas M. Overbey MD, Asimina Kiourti PhD, Satheesh Bojja-Venkatakrishnan MS, Dean J. Mikami MD, Jeffrey W. Hazey MD, and Thomas N Robinson MD have no conflicts of interest or financial ties to disclose.

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Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  • Edward L. Jones
    • 1
    Email author
  • Amin Madani
    • 2
  • Douglas M. Overbey
    • 1
  • Asimina Kiourti
    • 3
  • Satheesh Bojja-Venkatakrishnan
    • 3
  • Dean J. Mikami
    • 4
  • Jeffrey W. Hazey
    • 5
  • Todd R. Arcomano
    • 1
  • Thomas N. Robinson
    • 1
  1. 1.Department of SurgeryThe University of Colorado and The Denver VAMCDenverUSA
  2. 2.Department of SurgeryMcGill UniversityMontrealCanada
  3. 3.Department of Electrical and Computer EngineeringThe Ohio State UniversityColumbusUSA
  4. 4.Department of SurgeryThe University of HawaiiHonoluluUSA
  5. 5.Department of SurgeryThe Ohio State UniversityColumbusUSA

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