Alexander Abadir, MD1, Nabil El Hage Chehade, MD1, Nathan Park, MD2, David Eng, MD1, Jason Samarasena, MD3; 1University of California Irvine Medical Center, Orange, CA; 2University of California Irvine Medical Center, Irvine, CA; 3University of California Irvine, Orange, CA
Introduction: It is well known that looping may preclude successful advancement of the colonoscope for the practicing endoscopist. A novel dynamic rigidizing overtube (Pathfinder, Neptune Medical, Burlingame, CA) is now available to reduce risks associated with looping and facilitate colonoscopy completion. In its flexible state, the overtube material is soft and pliable, but in its rigid state becomes fifteen times stiffer when a vacuum is applied. This aids in stability and helps maintain a 1 to 1 relationship between force exerted on the shaft and motion at the scope tip by minimizing loop formation.
Methods: A 72 year old male presented for surveillance colonoscopy. The colonoscope was successfully advanced to the ascending colon, however could not be advanced further due to loop formation. Making the situation worse, every time the scope was advanced “through the loop” the patient became bradycardic to a heart rate in the 40’s, presumably from a vasovagal reflex. Repeated attempts at advancing the colonoscope were unsuccessful due to looping and bradycardia despite abdominal counterpressure and position change. The scope was removed and the rigidizing overtube device was introduced onto the scope. The scope with overtube was advanced to the ascending colon in its flexible state. Once in the ascending colon, the overtube was rigidized. The overtube allowed for easy cecal intubation and successful completion of colonoscopy without any loop formation. Discussion: The following video demonstrates the aforementioned case focusing on technical aspects of using this novel dynamic rigidizing overtube. The video furtherhighlights our single center experience of this device for difficult colonoscopy and its impact on in-procedure endoscopist workload.
Disclosures: Alexander Abadir indicated no relevant financial relationships. Nabil El Hage Chehade indicated no relevant financial relationships. Nathan Park indicated no relevant financial relationships. David Eng indicated no relevant financial relationships. Jason Samarasena indicated no relevant financial relationships.