Hideki Kobara, MD, PhD and Yasuhiro Goda, MD from the Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University in Kagawa, Japan presents this video case, “Application of endoscopic hemostatic forceps for uterine cervical bleeding.”
In our present video, first-ever application of endoscopic hemostatic forceps for active cervical bleeding is described.
This idea is based on the development of endoscopic devices and adept skills. Recently, endoscopic submucosal dissection (ESD) for malignant epithelial tumors have been well-established in the field of gastroenterology. This signifies that endoscopic proficiency has been more achievable and opportunities are easily accessible to many gastroenterologists. Accordingly, accomplishing this kind of case application, which needs accurate completion of hemostasis by using soft coagulation of hemostatic forceps, is a significant indication of progress in the endoscopic field.
Figure 1. A, Endoscopic view by using a flexible endoscope, showing a pulsatile bleeding site within wide ulcerations near the cervical opening. B, Endoscopic view showing an arterial vessel (blue arrows) detected by using a transparent cap (yellow arrows) and an endoscope with water jet function. C, Endoscopic view showing successful endoscopic hemostasis by using hemostatic forceps for the ruptured vessel, which was coagulated consecutively 5 times (2 seconds per 1 grasp) under direct vision. D, Endoscopic view showing the coagulation site treated completely by using the endoscopic hemostatic forceps. E, Endoscopic findings showing the disappearance of exposed vessels 2 days after treatment. F, Vaginal examination showing mucosal healing and scarring 25 days after treatment.
As to future possibilities to learn endoscopy, not only on-going collaboration between gastro-endoscopy and gynecology but also in treatments of other fields, endoscopists can play important roles. For example, ESD skills can demonstrate a curative resection of pharyngeal epithelial carcinomas. In addition, newly introduced concepts such as laparoscopic and endoscopic cooperative surgery (LECS), endoscopic full-thickness resection (EFTR), and natural orifice transluminal endoscopic surgery (NOTES), all entail ESD-related techniques of endoscopy. Although these ESD-related skills involve similar strategy to conventional surgical techniques, these treatments are minimally invasive and can provide many benefits (no scar, short hospitalization) to all patients. In conclusion, endoscopic treatments based on adept techniques and sophisticated devices, which derive from ESD, are applicable and can contribute to further developments of other fields. These aspects show that it is worthwhile for young doctors to learn the endoscopic field.
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