Use of the New NaviAid Enteroscopy System for Treatment of Bleeding Terminal Ileal Hamartoma

Abstract

Introduction: Recent balloon-assisted enteroscopy modalities have been successful in diagnostic and therapeutic interventions in the small bowel, in both anterograde and retrograde manner. However, they each have their unique platforms and cannot be used between different scope systems. The NaviAid enteroscopy is a new system which utilizes a through-the-scope balloon catheter as an anchor for advancement into the small bowel, and can be used through the biopsy channel of various scope systems. Case Report: We report a unique case of a 36-year-old female who presented with melena and symptomatic anemia, requiring blood transfusions. She underwent a non-diagnostic upper endoscopy; however, on colonoscopy exam, she had altered blood in the ileo-cecal valve. Terminal ileal intubation showed a bleeding distant polypoid lesion that could not be reached with the colonoscope. Biopsies showed a hamartamatous lesion. Video capsule endoscopy did not show any other lesions in the entire small bowel. A NaviAid-assisted retrograde enteroscopy was successful in reaching the lesion in the terminal ileum, which was successfully resected endoscopically. The path report showed an isolated hamartomatous polyp with negative margins and no signs of malignancy. She recovered uneventfully without any recurrence of bleeding or anemia. Discussion: The NaviAid balloon-assisted enteroscopy is a safe and effective single-operator system for performing deep enteroscopy using a conventional colonoscope. It eliminates the need of an overtube or special scope platforms. Recent studies have shown an overall diagnostic yield of 45%, with average depth of insertion of 89 cm when used in a retrograde manner. Our case demonstrates its successful clinical utility in complete endoscopic resection of bleeding distant small bowel lesion.