This ASG video tip is sponsored by Braintree, maker of the newly approved Soufflave and Soutab. This video will demonstrate how to attach the Cooke esophageal varisopein ligator to the gastroscope. For instructions regarding the Boston Scientific bander, please see the alternative video. The contents of this package include a wheel and pulley system, the bander cap itself, which is attached to a string which passes through the working channel, a blunt tip needle, and a crochet needle. The first step is to attach the pulley system to the gastroscope, but before doing so, please notice the mechanism itself. A groove is cut in the top wheel into which the string attached to the bander cap will be passed and secured. On the side of the wheel indicates that there are two ways to rotate the wheel, two-way versus one-way, clockwise rotation only, which is associated with firing. Next, we will attach this device to the gastroscope. The bander cap is removed. Again, this may be placed directly into the gastroscope through the top of the closed valve or, in this example, through the open valve. The valve is passed over the stem, seated in place, and then the mechanism is attached to the gastroscope. The blunt tip needle is used to perforate the membrane, which passes into the working channel, and then the crochet needle is passed through the membrane and out the working channel. Both ends of the crochet needle are the same. At this point, the bander cap and string are attached to the crochet needle. The string tip opposite the end of the bander cap is tied in a knot. The knot is secured in the crochet needle, and then the crochet needle is removed. At this point, the bander cap is attached fully to the tip of the gastroscope, and all slack in the string is removed by gentle withdrawal. If the string is pulled too tightly, the bands will fire prematurely. At this point, the knot at the end of the string is passed into the groove on the pulley system indicated earlier. Once it passes in, the knot is secured. With a clockwise rotation of the wheel, the string is tightened, and once resistance is felt, then the wheel is pushed inward toward firing, and the device is ready for banding. At this point, it is important to turn on the gastroscope light to assess the field of vision. In this case, the string obscures vision, and gentle rotation of the bander cap so that the strings are located in the lower left quadrant provides maximum field of view.

video tip

Braintree

esophageal varisopein ligator

gastroscope

banding