Doppler probe ultrasonography methods

Video 1  We report a case using DOP for post-ESD ulcer.

The Doppler Box DOP system (Compumedics, DWL, Germany; Fig. 2 ) and probe are marketed for use in vascular surgery departments ¹³ . The 16-MHz Doppler probe has a length and diameter of 2 m and 1 mm, respectively, and is reusable after gas sterilization or high-level liquid disinfection. The monitor includes a center screen that displays pulse waves and eight screens that display different scan depths. This system has a high-definition-compatible screen and produces a high-quality audible signal.

 The Doppler-BOX 16-MHz pulse-wave system with a reusable doppler probe and monitor. The Doppler probe ultrasonography (DOP) output signal is both visual and audible. Reproduced with permission from Compumedics, Inc.

We evaluated post-ESD ulcers using the following procedure. A water-jet scope (GIF-Q260 J or GIF-2TQ260M; Olympus Corp., Tokyo, Japan) attached to a transparent hood was used; the specific scope was selected according to the endoscopist’s preference. After routine coagulation of the NBVVs, the Doppler probe was pushed to the post-ESD ulcer at an angle of 60º and maneuvered mainly around the pigmented spots and NBVV to detect the whole ulcer. The Doppler pulse wave was observed to shift depending on the speed and direction of the blood flow relative to the probe. Blood flow sites were observed at depths of 0.5 to 5 mm. Once IVs were detected, additional coagulation was performed (HDB2418 W, Pentax Co, Japan) to a maximum depth of 3 mm. The subsequent disappearance of the corresponding Doppler pulse wave was then confirmed ( Fig. 3a , Fig. 3b , Fig. 3c , Fig. 3d and ^Video 1 ). IVs with a depth of > 3 mm were considered subserosal blood flow and were not coagulated ¹² .

Detection of a Doppler probe ultrasonography (DOP)-positive vessel at the post-ESD ulcer. The Doppler probe was maneuvered while observing the blood flow. b Visual graphic display of the three positive Doppler waves corresponding to the vessel. The blood flow velocity (cm/s) and time (s) are plotted on the Y axis and X axis, respectively. The blood flow depth (2.0 mm) is indicated at the upper left of the plot. c Performance of additional coagulation for the vessel. d The Doppler wave disappeared after additional coagulation of the vessel.