PMC4435282_01
X-ray showing the straightening of the bent transnasal endoscope (red arrow) with the use of a transoral endoscope (blue arrow). (A) The transnasal endoscope was locked in a coiled position. (B) The tip of the transnasal endoscope was successfully uncoiled.
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X-ray room with the scope still inserted. X-ray examination showed that the tip of the scope was coiled (Figure 1A, red arrow). After several initial unsuccessful attempts, the bent tip of the transnasal scope, through which biopsy forceps were inserted to encourage a straightened configuration, returned to the neutral position (Figures 1B and 2C).
Endoscopic views of the uncoiling of the transnasal endoscope through the transoral endoscope. (A) The transnasal endoscope was locked in a coiled position. (B) The bent tip of the transnasal endoscope was grasped with a snare. (C) The transnasal endoscope was straightened. (D) Withdrawal of the transnasal endoscope.
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Tokyo, Japan, Figure 2A). The tip of the transnasal scope was grasped with a snare from the transoral endoscope and pulled forcefully (Figure 2B, green arrow). After several initial unsuccessful attempts, the bent tip of the transnasal scope, through which biopsy forceps were inserted to encourage a straightened configuration, returned to the neutral position (Figures 1B and 2C). The straightened transnasal endoscope was finally withdrawn with only mild injury to the gastric mucosa (Figure 2D).
Opened base of the withdrawn transnasal endoscope. (A) Parts of the bending system in the normal position. The stopper (red arrow) is attached just proximal to the sleeve of the wire (blue arrow) to prevent overbending. The metal cover (yellow arrow) was removed to show the parts of the bending system. When the tip of the fiber is locked in a bent position, the wire should be cut at the green dotted line to release the tension in the wire. (B) A broken stopper found in the present case. The sleeve of the wire slid under the stopper. (C) Since the system is covered with a metal frame, the sleeve disturbed the sliding motion of the wire, rendering it impossible to release the bend through the controls in the handle.
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When the base of the endoscope is opened, there is usually a stopper (Figure 3A, red arrow), located next to the sleeve (Figure 3A, blue arrow) of the wire that controls the direction of bending. In the present case, the stopper was broken and the sleeve slid under the broken stopper (Figure 3B, red and blue arrows). Since this part is encased in a metallic frame (Figure 3A and 3C, yellow arrows), abnormal movement of the sleeve probably disabled the handle's ability to control the tip of the instrument.