Cap-assisted suction techniques have been described for food bolus extraction and foreign body removal 1 2 3 . However, video-based documentation of long cap-assisted suction – particularly for piecemeal removal or intraprocedural clot clearance – remains limited ( Fig. 1 ). Herein, we present two cases highlighting the versatility of this approach.
Fig. 1.
Left: Normal cap (M-201-11804; outer diameter 12.1 mm; tip protrusion length 4 mm; Olympus, Tokyo, Japan). Right: Long cap (MH-463; outer diameter 13.5 mm; tip protrusion length 12 mm; Olympus).
Case 1: A 93-year-old woman presented with complete esophageal obstruction caused by a large food bolus ( Fig. 2 a ). The push technique was not feasible ( Fig. 2 b ), and retrieval net attempts failed due to poor visualization and a narrowed lumen. Thus, the cap-assisted suction technique was attempted. First, a long transparent cap and overtube were mounted onto the endoscope ( Fig. 2 c ). Portions of the bolus were then suctioned into the cap, and the scope was withdrawn and rinsed ( Video 1 ). This cycle was repeated until 141 g of food was removed over 35 minutes under intravenous sedation. No complications occurred during the procedure ( Fig. 2 d ).
Fig. 2.
Case 1 images. a Pretreatment computed tomography image showing suspected esophageal food bolus impaction. The area delineated by the red line indicates the food bolus. b Pretreatment endoscopic image showing a large food bolus in the upper thoracic esophagus; endoscope insertion into the distal esophagus was not possible. c Pre-suction endoscopic image: the opening of the long cap positioned at the oral side of the food bolus. d Post-treatment endoscopic image showing the esophagogastric junction after complete removal of the food bolus.
Case 2: A 52-year-old man undergoing gastric endoscopic submucosal dissection (ESD) experienced spurting hemorrhage ( Fig. 3 a, b ). After achieving hemostasis, a large volume of clotted blood accumulated. Both the retrieval net and short cap-assisted suction techniques were ineffective, and long cap-assisted suction was subsequently attempted ( Video 1 ). The latter technique enabled effective clot removal, allowing safe continuation of ESD ( Fig. 3 c, d ).
Fig. 3.
Case 2 images. a Endoscopic image before endoscopic submucosal dissection showing early gastric cancer (0–IIc) on the anterior wall of the upper gastric body. b Intraprocedural endoscopic image showing active spurting hemorrhage during mucosal incision. c Pre-suction endoscopic image demonstrating the long cap opening located adjacent to the clot. d Post-suction endoscopic image following clot removal.
Clinical utility of long cap-assisted suction.
Video 1
Compared with conventional pull-based retrieval or external suction methods 4 5 , long cap-assisted suction offers improved control, soft tissue engagement, and a simplified setup without the need for additional tubing or general anesthesia. It is a simple and reproducible procedure that requires only standard equipment.
This method is particularly advantageous in emergency settings or during therapeutic procedures when time and visibility are critical. It offers a safe, cost-effective solution for difficult bolus or clot removal and may be integrated into routine endoscopy practice.
Endoscopy_UCTN_Code_TTT_1AO_2AD Endoscopy_UCTN_Code_TTT_1AO_2AL
Acknowledgement
We would like to thank Editage (www.editage.com) for providing English language editing services.
Footnotes
Conflict of Interest The authors declare that they have no conflict of interest.
Contributorsʼ Statement Nobutaka Doba: Conceptualization, Visualization, Writing – original draft, Writing – review & editing. Kosuke Shibayama: Data curation. Shinzo Abe: Investigation. Daiki Sakuma: Investigation. Masanobu Someya: Data curation. Kazuto Komatsu: Supervision. Shin Maeda: Supervision.
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E-Videos is an open access online section of the journal Endoscopy , reporting on interesting cases and new techniques in gastroenterological endoscopy. All papers include a high-quality video and are published with a Creative Commons CC-BY license. Endoscopy E-Videos qualify for HINARI discounts and waivers and eligibility is automatically checked during the submission process. We grant 100% waivers to articles whose corresponding authors are based in Group A countries and 50% waivers to those who are based in Group B countries as classified by Research4Life (see: https://www.research4life.org/access/eligibility/ ). This section has its own submission website at https://mc.manuscriptcentral.com/e-videos .
References
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