Abstract
Recent advances in small bowel imaging have increased the demand for retrograde small bowel enteroscopy. Retrograde small bowel enteroscopy can be technically challenging using currently available techniques. In addition, many institutions do not have single balloon or double balloon technologies available for retrograde small bowel enteroscopy. Our hypothesis was that by using an overtube to stent the colon, the 260 cm long enteroscope could obtain deep small bowel intubation rapidly and safely. Patients, Methods, and Materials: 11 patients were consecutively enrolled in this nonrandomized, noncontrolled pilot study. Informed consent was obtained from all pts. The Olympus SIF-140 260 cm enteroscope was used along with the Spirus Medical Vista-SB(VSB) overtube per anal. The Vista-SB is 100 cm long with a raised 5.5 mm spiral at the distal end. The spiral length is 20 cm and the outer diameter of the Vista-SB is 18.5 mm and the inner diameter is 12 mm. The proximal end of the Vista-SB has a locking collar that allows rotation of the Vista-SB while locking to the enteroscope. VSB was rotationally advanced over the enterosocope to the cecum. The enterosocope was then pushed through the overtube through the ileocecal valve into the ileum. Depth of small bowel intubation was estimated by visual criteria. Findings: Average age 47 yrs., sex 8F/3M, Indications-5 pts. anemia,6 pts. chronic diarhea and abdominal pain. Time to cecum averaged 8.5 min.(range 3-32), time to maximum depth in small bowel was 23 min.(range 16-51), total time of procedure 29.4 min.(range 21-60). Ave. maximum depth of small bowel intubation was 125 cm(range 40-240). Findings were one avm, 2 pts. with small bowel ulcerations. There were no complications. Conclusion: Use of the 260 cm enteroscope with the Vista-SB overtube for retrograde small bowel intubation was safe and successful in all cases. Average depth of insertion compares favorably with published results from other retrograde techniques. Average time of procedure is comparable or superior to other retrograde techniques. Use of the Vista-SB overtube and the 260 cm enteroscope is a viable alternative for retrograde small bowel intubation and should be considered in institutions that do not have double-balloon or single balloon enteroscopes.
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