To evaluate the efficacy of a modified Transurethral Resection (TUR) set attached to the biopsy channel in enhancing suction and lavage efficiency during gastroscopy in patients presenting with fluid-filled or food-filled esophagus and stomach, conditions frequently associated with procedural delay and increased aspiration risk

A six‑month prospective comparative assessment was conducted on upper gastrointestinal endoscopy cases performed under propofol–fentanyl sedation. Despite an 8-hour fasting protocol with clear liquids allowed up to 3–4 hours before the procedure, selected patients had retained residue in the esophagus or stomach. Sixty such cases were randomized into two equal groups: Arm A (standard biopsy-channel suction) and Arm B (modified TUR-set suction). Residue volume per case ranged from 200 mL to 700 mL. Time required to achieve clearance of 300 mL of residue was recorded for several residue categories including clear fluid, thick liquids, soft food, solid fibrous material, fresh blood clots, and organized blood clots. Percentage improvement in clearance time was derived to quantify effect size.

The modified TUR-set system consistently reduced clearance time across all residue types. The observed improvements were as follows:For clear fluid and bile, the average clearance time improved from 1 minute 15 seconds to 50.4 seconds, representing a 32% reduction. In patients with achalasia and a fully distended esophagus, clearance time improved from 8 minutes 22 seconds to 5 minutes 16 seconds, corresponding to a 37% reduction. Thick semisolid residue such as altered milk or curd showed a reduction from 4 minutes 21 seconds to 2 minutes 53 seconds, translating to a 34% improvement. Similarly, soft food materials such as rice, digested egg, and other easily fragmentable substances demonstrated a strong benefit; clearance time declined from 5 minutes 11 seconds to 3 minutes 19 seconds, indicating a 36% improvement. Solid food with fibrous texture showed only modest enhancement—14 minutes 52 seconds versus 12 minutes 34 seconds—amounting to a 15% reduction. Fresh blood clots showed one of the highest benefits: clearance time decreased from 12 minutes 29 seconds to 7 minutes 31 seconds, a 40% improvement. Organized clots, being more cohesive and resistant to fragmentation, showed limited improvement of 13%, decreasing from 14 minutes 37 seconds to 12 minutes 42 seconds. Aspiration events occurred in 23.3% of patients in the standard-suction arm compared with 10% in the TUR-set arm, corresponding to a 57% relative risk reduction.

Discussion:Effect-size analysis based on percentage reduction in clearance time demonstrates clinically meaningful and consistent superiority of the modified TUR set over standard suction. The ability to rapidly declog the system using intermittent air flushing from an assistant-controlled syringe proved especially valuable for viscous fluids, semisolids, and fresh clots. This prevented the repeated need to remove the suction valve or use a cleaning brush—steps that otherwise prolong the procedure and increase aspiration risk. The strongest benefits were observed in fresh blood, fluid blood, and soft food residue, where high-flow suction combined with rapid channel clearance significantly shortened the time needed to restore adequate visualization. For fibrous solids or organized clots, both systems performed poorly, highlighting the intrinsic physical limitations of endoscopic suction in these materials.The reduction in aspiration events reinforces the safety benefit of the modified TUR system. Faster clearance in a stomach or esophagus loaded with retained residue inherently reduces the duration during which regurgitation and aspiration can occur. Additionally, uninterrupted suction flow improves procedural efficiency, decreases operator fatigue, and allows earlier progression to therapeutic interventions when required.

The modified TUR set provides a practical, low-cost, and highly effective enhancement to biopsy-channel suction during gastroscopy in patients with retained fluid, food residue, or blood. Percentage improvement analysis shows substantial reductions in clearance time—particularly for soft food materials, altered blood, and fresh clots. The device also reduces aspiration events, suggesting an important safety advantage.