The ShapeLock™ Endoscopic Guide Facilitates Successful Colonoscopies After Previously Failed Attempts in Difficult Cases

Abstract

Background: Failure to intubate the cecum is not uncommon in prospectively audited surveys, occurring up to 5% or more of the time or more. Approximately half of these cases are due to the anatomically challenging colon itself, with difficult loops or excessive length. Negotiating such difficult loops can cause pain, increase the risk of perforation and may result in unpredictable delays in the procedure and occasionally, altogether failure. We have previously demonstrated in a pilot trial that facilitated introduction of the colonoscope via the use of the ShapeLock™ Endoscopic Guide (USGI Medical, San Clemente, CA) is safe and feasible with the potential for making colonoscopy easier, less painful and safer. Aims: To assess the efficacy of this technology in facilitating a complete colonoscopy in previously failed cases. Methods: In an ongoing prospective trial, patients were recruited at two centers with criteria of having failed at least one attempt at a complete colonoscopy due to factors other than obstruction, incomplete preparation or instrument failure. As previously described, the Shapelock consists of a flexible sheath inserted over the endoscope and that can be instantly rigidized by activation of uniquely designed interlocking plates, thus preventing further looping. In addition, various maneuvers can be performed through the unlocked ShapeLock to shorten and straightening of the colon. Results: Four patients (mean age = 54.25 + 8.6; all female) have been recruited as part of an ongoing prospective trial. All patients had recently undergone an unsuccessful colonoscopy by an experienced endoscopist with the reason for failure in all four being “excessive looping”. Using the ShapeLock, cecal intubation was successful in all patients without application of abdominal pressure or change in position of the patient. The device was rated highly by the endoscopist both in ease of use and facilitation of the procedure. No adverse effects were noted. Conclusions: The ShapeLock appears to be an effective and highly promising tool for difficult and previously failed colonoscopies. Further, because of its safety, it also has the potential for facilitating routine colonoscopies by eliminating difficulty with even minor looping in the sigmoid.