S0972 Enteroscopy Enabled Using a Novel Dynamic Rigidizing Overtube: An Initial Single Center Experience

Abstract

INTRODUCTION: Single or double balloon enteroscopy is able to visualize the small bowel well but is not readily available due to the cost and procedural expertise required. A novel dynamic rigidizing overtube is now available to assist with difficult colonoscopy. In its flexible state, the overtube material is soft and pliable, but in its rigid state becomes 15× stiffer when a vacuum is applied. This aids in stability and minimizing loop formation. The aim of this study was to assess feasibility and safety of this novel device for use in performing antegrade and retrograde enteroscopy. METHODS: This was a retrospective study over a 6 month period in which two endoscopists performed retrograde and antegrade enteroscopies using a novel rigidizing overtube. Retrograde enteroscopy was performed via the anus by advancing the overtube to the cecum in its flexible state with the pediatric colonoscope, reducing the scope and overtube construct, and then rigidizing at the cecum. Following rigidization, the scope was pushed through the ileocecal valve and advanced maximally. Antegrade enteroscopy was performed by inserting the dynamic rigidizing overtube with use of the pediatric colonoscope via the mouth, rigidizing in the duodenum or jejunum, and then advancing maximally. RESULTS: A total of 9 retrograde and 3 antegrade enteroscopies were performed. On retrograde enteroscopy, small bowel depth ranged from 15cm to 70cm from the ileocecal valve, with a mean of 48.9cm. There were no complications associated with use of the dynamic rigidizing overtube, both in antegrade and retrograde evaluation. Of note, in one case, initial attempts at retrograde double-balloon enteroscopy failed due to looping and unfavorable angulation of the ileocecal valve. Multiple attempts at intubation including manual abdominal pressure and position changes were unsuccessful. The dynamic rigidizing overtube was then introduced with successful intubation and subsequent exploration of the ileum. Overall, both endoscopists reported significant ease of enteroscopy compared to traditional double-balloon methods, with lower perceived mental and physical demand. CONCLUSION: In this initial study, the novel dynamic rigidizing overtube successfully facilitated both antegrade and retrograde enteroscopy without adverse events. Our results suggest that use of this dynamic rigidizing overtube may have a role in performing enteroscopy in select patients.Figure 1.: Image of the rigidizing overtube. The overtube is placed at the hub of the colonoscope, allowing free tip movement. When the vacuum is applied, the normally flexible overtube becomes fifteen times as rigid, allowing 1 to 1 movement when force is applied to the shaft of the colonoscope.