1- you can introduce the injector when the scope in the normal position before retroflection (when the endoscope is looking to the pyloric ring).It can be challenging to do that in the retroflexed situation.
2-you can cut a small piece from the tip of the injector 1-2 mm to elongate the tip of the injector needle (better with a scissor to maintain the tip of the nozzle smooth).
3- injection of 0.5 to 1 ml of distilled water or saline before the infusion of amacryl as it expands the gastric varices with a comfortable injection of amacryl also, the endoscopist becomes sure that the needle is well fitted to the variceal lumen, i.e., avoiding loss of the injected material.
4-injection of 0.5 to 1 ml of water after injection to ensure that all the injected material is successfully infused into the variceal lumen.
5-you can guess varix before injection with the tip of the plastic portion of the injector and evaluate its softness. Also, after the injection of varix, you can reexamine it and detect the change of consistency from soft to hard ( denoting successful injection of varix).
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