Post written by Yoshikazu Hayashi, MD, PhD, from the Department of Medicine, Division of Gastroenterology, Jichi Medical University, Shimotsuke, Japan.

Our article describes a 62-year-old patient with a laterally spreading tumor in the cecum. We developed “the Asclepius tube”—a modified, fenestrated 14F nasogastric tube (SF-GX1420, Terumo, Tokyo, Japan) wrapped around the distal end of the endoscope, allowing for continuous, passive drainage of gas and fluids. This method reduces the need for active suctioning, stabilizes the submucosal pocket, and enhances visualization without impairing endoscopic maneuverability.

The Asclepius tube provides multiple advantages over conventional methods:

• Consistent drainage—Enables continuous removal of luminal gas and fluid, minimizing the need for frequent aspiration.
• Enhanced maneuverability—Helps maintain a stable, collapsed lumen, facilitating precise submucosal dissection.
• Cost-effectiveness—Costs only 0.60 U.S. dollars, making it a highly affordable adjunct for endoscopic submucosal dissection (ESD). It is constructed from readily available materials.

Our experience suggests that the Asclepius tube can improve the efficiency of cecal ESD and may offer broader applications in other challenging endoscopic procedures.

This technique highlights the value of simple-yet-effective modifications in advancing therapeutic endoscopy. By incorporating the Asclepius tube into their practice, endoscopists may achieve improved efficiency in colonic ESD through enhanced endoscopic maneuverability and continuous removal of luminal gas and fluid.

In addition, the Asclepius tube may be beneficial for saline immersion therapeutic endoscopy and water pressure ESD by facilitating water volume control and efficient removal of bubbles that electrosurgical currents generate. This added function further enhances its use in maintaining a clear endoscopic field and optimizing procedural outcomes.

A, Photograph and (B) graphic representation of the drainage tube wrapped around the distal part of the endoscope. Additional side holes (fenestrations) were cut on the distal part of a 14F 125-cm nasogastric tube. The tip of the tube was cut diagonally, wrapped to the colonoscope tip, and fixed with vinyl tape. A conical distal attachment (DH-33GR; Fujifilm, Tokyo, Japan) with the side slit covered with a piece of transparent tape is attached to the colonoscope tip.

Read the full article online.

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