S2154 Utilizing the Mobile Pure-Vu System for Bedside Inpatient Colonoscopy: A Novel Technique

Abstract

Introduction: Colonoscopy is considered the standard for evaluating patients with suspected colonic disease. A key factor in ensuring high quality colonoscopy is adequate colon cleansing. Unfortunately, in hospitalized patients, bowel preparation is often challenging and bowel cleansing is often due to patient’s inability to tolerate the preparation, slow bowel transit in the setting of immobilization and acute illnesses, and due to the use of motility-altering medications. Poor bowel preparation limits visualization of the colonic mucosa and this can lead to incomplete colonoscopies, missed pathology, adverse events, prolonged hospital stays and increased costs. Due to this recurrent problem, new technologies have been developed to improve bowel preparations intra-procedurally. One of those is the Pure-Vu EVS system, which is an over-the-scope irrigation and cleansing device. This case report describes the first use of the Pure-Vu EVS system for mobile bedside colonoscopy in an intensive care setting. Case Description/Methods: A 63-year-old Black male with a past medical history of cerebral vascular disease, hypertension, diabetes and chronic kidney disease presented from his rehabilitation facility with reported melena. The patient was found to be hypotensive and determined to be in hemorrhagic shock. The patient was admitted to the intensive care unit, initiated on pressors and administered colloids. The patient then underwent urgent bedside esophagogastroduodenoscopy which revealed no source of bleeding. A CAT scan was obtained which demonstrated no targeted source of bleeding for interventional radiology. The patient was then administered 2 liters of Polyethylene Glycol 3350 and underwent same day bedside colonoscopy. A Motus GI Pure-Vu EVS system was loaded onto a colonoscope and the colon was cleansed from a Boston bowel prep score of 4 to 8. An actively bleeding angioectasia was identified in the cecum and hemostasis was achieved with a hemoclip. The patients shock resolved and the bleeding ceased (Figure). Discussion: The newest version of Pure-Vu EVS is more compact and readily transportable. It’s design makes it ideal for utilization in mobile colonoscopy cases. This case illustrates the potential benefits of utilizing the Pure-Vu EVS system in mobile endoscopy cart and the potential to improve outcomes such as Boston Bowel prep score, rates of diagnosis, adenoma detection rates and ability to achieve hemostasis. Trials are currently underway examining this potential.Figure 1.: Angioectasia identified after bowel cleansing with Pure-Vu EVS.