Intestine - A Novel Device for Endoscopic Advancement Through the Small Bowel
Comments: The Endoease Discovery SB is a 55 French 130 cm overtube with a 5mm raised helical element at its distal end. The Discovery SB is placed over the pediatric colonoscope. The locking device permits fixing the Discovery SB to the colonoscope for spiral advancement or unlocking to permit pushing of the colonoscope through the overtube.
To achieve pleating of the small bowel by rotation of the Discovery SB, the spiral segment of the overtube must be advanced past the ligament of treitz. Once past the ligament of treitz, the mobile small bowel can be pleated on the overtube using spiral technique.
To achieve positioning of the Discovery SB and pediatric colonoscope past the ligament of trietz spiral advancement with gentle push is used or the overtube is unlocked and the pediatric colonoscope is advanced deeply into the small bowel.
The Discovery SB is then rotationally advanced over the endoscope past the ligament of trietz.
Rotational advancement through the small bowel can be achieved by pleating of the small bowel on the Discovery SB. All advancement seen here is by rotation and pleating of the small bowel. Two operators are required, one for spiraling and a second for steering and insufflation to maximize insertion. Minimal insufflation is used and the lumen is centered in the viewing field during rotation.
Spiral advancement is continued as long as the overtube rotates easily and the small bowel continues to be pleated onto the Discovery SB. When advancement slows or rotation becomes difficult the overtube may be straightened and or pulled back to remove loops. This achieves a strait scope that is optimal for spiral advancement. Advancement through the small bowel can be achieved as seen here.
All advancement seen here is by spiraling the Discovery SB and pleating of small bowel on the overtube. When working optimally the spiral advancement has a rapid one to one advancement with a minimal slippage of the Discovery SB spiral. Ineffective rotation of the Discovery SB does not appear to damage the small bowel mucosa.
Deep small bowel intubation can be achieved as seen here. Fluoroscopic guidance was not used in this case but may be useful to assist in advancing through the small bowel.
When advancement slows and rotation becomes less effective the overtube is straightened and pulled back.
Rotations then continue until advancement again slows or becomes difficult. The pediatric colonoscope can also be advanced through the Discovery SB by unlocking the overtube from the endoscope and pushing the endoscope through the overtube.
The Olympus pediatric colonoscope has advantages for working in the small bowel. The 3.2 mm working channel accepts all standard accessories. As seen here a hemoclip is applied to mark the depth of insertion. The endoscope can also be withdrawn completely from the overtube and reinserted without loss of position.
Withdrawal of the Discovery SB and endoscope is accomplished by counter clockwise rotation of the overtube. The counter clockwise rotation unpleats the small bowel from the overtube. Fine control of small bowel can be achieved to unpleat and if necessary pleat the small bowel. This allows controlled therapy when necessary. Minimal mucosal trauma is seen on withdrawal. The smooth raised helical element does not appear to cause significant trauma to the mucosa. Mucosal trauma seen here was limited to the pylorus and upper esophageal sphincter. Here fine control of the small bowel withdrawal is seen.
The mucosa was normal appearing and no evidence for small bowel hypo perfusion was seen on this examination. As the scope is withdrawn the operator used minimal insufflation and minimal steering is needed as the small bowel unpleats. If required the enteroscope can be completely removed and reinserted without loss of position.
The Endoease Discovery SB is an exciting technology with significant promise for visualization of the small bowel. Small bowel advancement is rapid with minimal trauma and excellent controlled withdrawal. Using this technology with Olympus pediatric colonoscopes allows all standard therapies to be employed.
Future studies comparing the Discovery SB with double balloon enteroscopy will be needed. Improvements to minimize the overtube diameter and decrease mucosal trauma are underway.
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Paul A. Akerman, MD Director of Endoscopy and Endoscopic Oncology Brown University Daniel Cantero, MD Brown University Jesus Pangtay, MD Brown University |
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Citation: Akerman, PA & Cantero, D. & Pangtay, J. (May 21 2007). Intestine - A Novel Device for Endoscopic Advancement Through the Small Bowel. The DAVE Project. Retrieved Sep, 8, 2010, from http://daveproject.org/viewfilms.cfm?film_id=607 Times viewed since Feb 2006: 8702 |
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