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Fig. 20.1 Endoscopic irrigation device (Endowasher, MTW). a Irrigation from the working channel of the colonoscope.

Adaptor attachment placed on the working channel to transport irrigation water from the pump into the endoscope.

Pump.

Bipolar Coagulation Probe

Fig. 20.2 Bipolar coagulation.

a Principle of bipolar coagulation. The electrical current flows (arrow) from the electrode in the probe tip through the tissue to the other electrode. b ACMI bipolar probe. Steel electrodes lying lengthwise and parallel to one another in the tip.

Fig. 20.2 Bipolar coagulation.

a Principle of bipolar coagulation. The electrical current flows (arrow) from the electrode in the probe tip through the tissue to the other electrode. b ACMI bipolar probe. Steel electrodes lying lengthwise and parallel to one another in the tip.

Injection Gold Probe

Fig. 20.3 Injection Gold Probe (Boston

Scientific).

a Probe with electrodes spiraling around the tip. On the left, the built-in needle is extended, allowing, e.g., epinephrine injection to achieve hemostasis and improve visualization. After injection, the needle is withdrawn and coagulation begins.

b Endoscopic view. Injection Gold Probe is placed on the mucosa (images courtesy of Boston Scientific).

Fig. 20.3 Injection Gold Probe (Boston

Scientific).

a Probe with electrodes spiraling around the tip. On the left, the built-in needle is extended, allowing, e.g., epinephrine injection to achieve hemostasis and improve visualization. After injection, the needle is withdrawn and coagulation begins.

b Endoscopic view. Injection Gold Probe is placed on the mucosa (images courtesy of Boston Scientific).

tivity as tissue desiccation increases limits depth and breadth of tissue damage as well as maximum temperature (100 °C). Bipolar probes generally have an opening at the tip for irrigation (Fig. 20.2b), the effect of which is two-fold: improved visualization of the bleeding source and formation of a thin film of fluid separating the probe from the tissue and preventing adhesion. If the probe tip sticks to the tissue, the electrical current is interrupted and the probe must be removed from the endoscope and cleaned. Removal of the adhered probe in turn entails the additional risk of tearing tissue and inducing bleeding. One study reports this occurring in 18% of applications for peptic ulcers (19). Probes are also available which include an extendable needle at the tip (Fig. 20.3), allowing quick alternation between injection and coagulation therapy, which can have distinct advantages in critical situations.

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