by Klaus Klaus Mönkemüller, MD, PhD, FASGE, FJGES
Department of Gastroenterology, Carilion Memorial Hospital, Virginia Tech Carilion School of Medicine, Roanoke, USA
The Duette device (Figure 2, Figure 1D) is essentially an endoscopic banding device for varicesaccompanied by a hexagonal snare. Let’s dwell into this practical device used for endoscopic resection.
The objective of suctioning and banding gastrointestinal mucosal lesions is to a) reshape a flat or semi-sessile lesion into a “sessile” form, b) have the band at the base and assure a better endoscopic resection (R0).
The other significant novelty of the Duette device is the 5Fr hexagonal snare (Figure 1). If you would use a banding kit and then try to advance a traditional snare (usual diameter of the snare catheter or sheath is 7Fr), it would be impossible to push it through the working channel of the scope, as there is a string for the bands inside running from the “firing device” inside the working channel of the scope (Figure 1J, yellow arrow). When using Duette, pushing the 5Fr snare into the working channel, along the string, is quite easy (Figure J, yellow arrow). There are some special tricks that may be useful in to facilitate snare catheter insertion. As shown in Figure 1D the snare can be pulled well inside the catheter. Pulling “ears” or handle rings are proximal (Figure 1D, yellow arrow). However, before inserting the snare-catheter into the working channel of the scope, we prefer to have the snare close the catheter tip (Figure 1F), as this maneuver “stiffens” the catheter and allows for a better introduction into the working channel, along the string of the band-firing device (Figures 1H, 1I, 1J). Not uncommonly, the catheter tip may bend when trying to push it into the working channel. By having the snare at the tip of the catheter, bending is less likely. There are three tricks to verify that the snare is at the tip: a) visualization (Fig. 1F) (which sometimes is not easy in the somewhat darkened endoscopy suite, b) placing tip of finger on catheter, and “feeling” when the snare tip is pushed out by the assistant, or c) looking at the centimeter marking at the handle, as the 4 cm mark corresponds to the snare being located at the tip of the catheter (Figure 1 G). Now the snare can be easily inserted into the working channel (Figure 1I).
No COI by KM with any of the companies/utensils or products mentioned in this article. All photos taken by KM. Property of EndoCollab.
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