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Initial experience of a through-the-scope balloon device for ileal intubation in Crohn's disease

2013; Elsevier BV; Volume: 78; Issue: 4 Linguagem: Inglês

10.1016/j.gie.2013.05.019

1097-6779

David T. Rubin, Sarah R. Goeppinger,

Gastrointestinal Tumor Research and Treatment

Intubation of the terminal ileum (TI) is necessary to assist in the diagnosis of suspected Crohn's disease (CD) and is the preferred method to assess disease activity or postoperative recurrence in patients with known CD. However, a number of factors may limit successful ileal intubation, including anatomic difficulties of the native disease, acute angles of anastomoses, and fibrostenosis. Additionally, ileal CD may spare the most distal TI, so deeper intubation is required to assess this effectively. Other modalities of assessment have been limited by their inability to biopsy (capsule endoscopy or radiologic imaging) or the requirement of special equipment (deep enteroscopy with current single- or double-balloon devices). The Navi-Aid (Smart Medical Systems, Ra'anana, Israel) (Fig. 1) is a through-the-colonoscope balloon device with a single pressure-sensitive, automated insufflation balloon that enables the endoscopist and assistant to “pull” the colonoscope deeper into the ileum (Fig. 2) while the balloon anchors it further inside. Navi-Aid is a U.S. Food and Drug Administration-approved endoscope accessory that ensures positioning of a standard endoscope in the small intestine.Figure 2Deployment of the Navi-Aid in a patient with known Crohn's disease. A, The device is embedded in the ileum proximally. B, After automated balloon insufflation, the colonoscope is pushed by endoscopist while the assistant “pulls” the small bowel toward the tip of the colonoscope.View Large Image Figure ViewerDownload Hi-res image Download (PPT) We used the Navi-Aid balloon device in 6 patients with known (n = 3) or suspected (n = 3) CD who underwent ileocolonoscopy. After initial attempts to deeply intubate the ileum, the Navi-Aid device was deployed, and the incremental intubation length recorded. In all patients, Navi-Aid deployment was successful, with incremental intubation of an additional 15 to 60 cm. The procedure was well tolerated, and there were no adverse events. In all patients, clarification of disease activity and diagnosis were successfully achieved. This is the first description of the Navi-Aid for known or suspected CD. In our experience, this device offers a novel and convenient option for the assessment of such patients, especially when unsuspected procedural technical difficulties are encountered. A new through-the-scope balloon-assisted deep enteroscopy platformGastrointestinal EndoscopyVol. 79Issue 4PreviewWe read with interest the letter by Rubin and Goeppinger1 in the October issue of Gastrointestinal Endoscopy regarding their experience with the NaviAidAB through-the-scope balloon (Smart Medical Systems, Ra'anana, Israel). Full-Text PDF