This ASG video tip is sponsored by Braintree, maker of the newly approved Soufflave and Soutab. Inside the banner kit are several pieces of equipment, including the wheel and wire attachment, which passes through the gastroscope, a flush port, which is not necessary most of the time because we have washing gastroscopes, so I'll place that aside, and then the banner cap itself with the bands attached. So the first thing is, after turning off the light of the gastroscope, is to attach the pulley system to the gastroscope and then the banner cap to the pulley system. So first, I'll begin by removing the banner cap. Now there will be three ways that this can be placed. One is directly onto the gastroscope. One method is through the intact cap with the valve closed. The method that I'm going to show you though is with the cap open. So with the cap open, the wire is passed through the cap, the wire is passed all the way through, and then seats fully onto the wheel and pulley system. This gives a secure seal to prevent air leakage and also provides stability, although remember that any of those three options may be used with attaching the wheel. After that, the wire is passed down the working channel of the gastroscope and passes out of the end of the working channel. At this point, the banner cap seats fully onto the gastroscope. At this point it's fairly stable, but this kit also has a Velcro band that allows securing of the wheel to the gastroscope. So once this is released, it passes behind the gastroscope through the metal eyelet and then seals on itself. So we have a secure pulley system with a great seal to prevent leakage of air. So now turning our attention to the banner cap itself, the banner cap has a string attached and will be attached loop-loop system similar to the method that a peg tube is attached. The string passes through the metal eyelet and then the banner cap passes through the string. Once this is secured, then the wire is withdrawn through the working channel so that the banner cap will fit on the end of the gastroscope. The cellophane seal around the banner cap helps prevent premature firing of the bands. It can be removed at any time. I tend to remove it partially in the beginning until the banner cap is fully fitted on the gastroscope to prevent premature firing of the bands, although it can be removed from the beginning. So once the cellophane has been peeled back, the banner cap will fit on the tip of the gastroscope. Once it's fully in place, the slack of the wire may be pulled and then it fits into a notch in the back of the wheel and is secured. The excess wire may then be cut with a wire cutter or may be tied to the gastroscope so that it is not in the way. Then the cellophane is fully removed from the banner cap and now the banner cap and firing mechanism are attached. At this point, it's important to turn on the light of the gastroscope. Looking at the endoscope view, it's important to notice that the pulley mechanism, the string, obscures the field of view. Also notice the notches along the banner cap where the firing mechanism pulls. So by rotating the banner cap so that the string is in the lower left quadrant approximately 7 o'clock, also these notches are in the lower left quadrant, there is a maximum field of vision for when the gastroscope and banner cap are passed into the esophagus.

video tip

Braintree

banner cap

gastroscope

pulley system