Dear Aiman,

The following are alternative methods to endoscopy:

1- An alternative method of endoscopic retrieval of a proximally migrated biliary plastic stent using a "sphincterotome hooking the stent" technique:

For more on this technique, please see the recent paper:

Endoscopy. 2015;47 Suppl 1 UCTN:E64-5. doi: 10.1055/s-0034-1391242. Epub 2015 Feb 17.

http://www.ncbi.nlm.nih.gov/pubmed/25926216

2-Anti-fogging techniques for rigid and flexible bronchoscopes

Anaesthesist. 2012 Dec;61(12):1036-44. doi: 10.1007/s00101-012-2116-z. Epub 2012 Dec 13.

[Comparison of antifog methods in endoscopy. What really helps].

[Article in German]

Knauth A1, Weiss M, Dave M, Frotzler A, Haas T.

Author information

Abstract

BACKGROUND:

The use of a flexible or rigid fiberoptic bronchoscope belongs to the standard repertoire in anesthesiology. Besides a lack of training these procedures may be considerably compromised by endoscopic lens fogging. Several antifogging approaches are commercially available but to date no controlled studies regarding the efficacy of these devices in bronchoscopes exists. The aim of the present study was to compare the efficacy of different commercially available anti-fogging techniques for rigid and flexible bronchoscopes.

MATERIALS AND METHODS:

The study was performed at the department of anesthesia in a university children's hospital. An artificial airway model was created to simulate in vivo conditions with respect to airflow, temperature and atmospheric moisture. A test picture was inserted into the artificial airway for assuring a standardized view through the bronchoscopes. Antifogging efficacy of two liquid antifog solutions (Ultrastop and Anti-Fog), two antifog wipes (Lina Clear and Reso Clear) and an induction endoscope preheater system (used after one and two induction preheating phases) was assessed by video taping of the bronchoscope view of the test picture. In addition the administration of continuous oxygen airflow of 2 l min⁻¹ through the suction channel of the flexible bronchoscope was tested as an alternative method to prevent lens fogging. All final pictures were rated by 10 staff anesthesiologists who were blinded to the antifog devices used. To assess the clinical relevance of the results, ratings were classified into a 5 grade rating scale (ranging from no visualization of any structure to excellent endoscopic view allowing safe endotracheal intubation). In addition, the failure rate of each anti-fog technique was calculated.

RESULTS:

A total of 300 endoscopic test pictures were taken and assessed. Using the flexible bronchoscope, the use of anti-fog solution (failure rate 3 %) and Lina Clear wipes (failure rate 4%) showed the best results. In the rigid bronchoscope group Ultrastop solution (failure rate 5 %) and Lina Clear wipes (failure rate 3.5 %) showed superior results. The two-time use of the endoscope preheater system was effective using flexible (failure rate 6 %) and rigid bronchoscopes (failure rate 10 %). The application of a continuous oxygen flow of 2 l/min failed to provide a clear endoscopic view (failure rate 93.5 %).

CONCLUSIONS:

All commercially available antifog liquids and wipes showed slightly different reduction of lens fogging. However, other factors such as frequency of usage, the type of endoscope, hygiene properties as well as cost-effectiveness might have a substantial impact on the comparison of all tested anti-fog devices. The use of an endoscope preheater system might be a conceivable alternative method to reduce lens fogging despite the higher initial cost. However, the multiple use of the preheater system cannot be recommended at present as additional handling procedures to ensure an appropriate but safe temperature of the endoscopic tip should be provided by the manufacturer. Application of a continuous oxygen flow was shown not to be effective in preventing lens fogging using a flexible fiberoptic bronchoscope.

http://www.ncbi.nlm.nih.gov/pubmed/23247535

3-An alternative method for mucosal flap closure during peroral endoscopic myotomy using an over-the-scope clipping device.

Endoscopy. 2013 Jul;45(7):579-81. doi: 10.1055/s-0032-1326398. Epub 2013 Apr 16.

An alternative method for mucosal flap closure during peroral endoscopic myotomy using an over-the-scope clipping device.

Saxena P1, Chavez YH, Kord Valeshabad A, Kalloo AN, Khashab MA.

Author information

Abstract

Maintaining the integrity of the mucosal flap and the reliable closure of mucosal entry during peroral endoscopic myotomy (POEM) is paramount in preventing leakage of esophageal contents into the mediastinal space. We describe our experience with POEM, the problems encountered with closure of mucosal flaps, and successful closure with over-the-scope clips (OTSC). Two patients with achalasia underwent successful endoscopic myotomy during POEM. During both procedures, the proximal end of the longitudinal mucosal incision was noted to be gaping and completion of the closure with standard clips was unsuccessful. The sides of the flap were approximated using a Twin Grasper followed by placement of OTSC. Closure of the mucosal entry appeared to be complete at the end of the procedures. Esophagram the following day revealed no leaks in either patient. There were no other complications and patients were discharged home after 1 - 2 days of hospital observation. Patients reported complete resolution of achalasia symptoms during follow-up. We propose closure of mucosal incisions during POEM using one to two OTSC as an alternative to described techniques. The use of OTSC may simplify the procedure and result in a more durable (i. e. full-thickness) closure.

http://www.ncbi.nlm.nih.gov/pubmed/23592391

4- http://www.cbsnews.com/news/less-invasive-methods-may-provide-options-for-colorectal-cancer-screening/

Hoping this will be helpful,

Rafik

thank you for such a brief answer