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A new through-the-scope balloon-assisted deep enteroscopy platform

2014; Elsevier BV; Volume: 79; Issue: 4 Linguagem: Inglês

10.1016/j.gie.2013.10.034

1097-6779

Vivek Kumbhari, Payal Saxena, Mouen A. Khashab,

Gastrointestinal disorders and treatments

We read with interest the letter by Rubin and Goeppinger1Rubin D.T. Goeppinger S.R. Initial experience of a through-the-scope balloon device for ileal intubation in Crohn's disease.Gastrointest Endosc. 2013; 78: 669-670Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar in the October issue of Gastrointestinal Endoscopy regarding their experience with the NaviAidAB through-the-scope balloon (Smart Medical Systems, Ra'anana, Israel).We have also found this device useful to facilitate assessment of the distal ileum in patients with suspected Crohn's disease. To date, we have performed 24 retrograde enteroscopies using this platform, 3 for the diagnosis and management of suspected ileal Crohn's disease. We agree that no specialized training is required and that the learning curve is swift. We wish to emphasize that an adult colonoscope is necessary because the through-the-scope balloon requires a minimum working channel diameter of 3.7 mm.A concern in our early experience was advancing the balloon catheter in a blind fashion in patients with a potentially inflamed and friable ileal mucosa. However, because of the soft tip and flexible nature of the balloon catheter, we found that resistance was easily discerned. If excessive force was used to advance the balloon catheter, it would simply retroflex. Initial concerns also included blind inflation of the balloon when it was inadvertently placed within a stricture, resulting in unintended dilatation and possible perforation. However, the pressure-sensitive balloon appears to recognize the stenosis, and inflation does not occur.In our experience, the endoscope was surprisingly able to maintain a stable position during the advancement of the deflated balloon catheter without losing the ground gained. This resulted in challenging therapeutic interventions being performed (eg, polypectomy, enteral stent insertion) with standard accessories by using the larger working channel that accompanies the adult colonoscope as compared with the enteroscope. Another benefit over standard deep enteroscopy platforms is the ability to intubate the ileocecal valve by using the inflated balloon to pull the colonoscope into the terminal ileum. This may overcome a frustrating and challenging step in ileocolonoscopy.2Mehdizadeh S. Han N.J. Cheng D.W. et al.Success rate of retrograde double-balloon enteroscopy.Gastrointest Endosc. 2007; 65: 633-639Abstract Full Text Full Text PDF PubMed Scopus (66) Google ScholarDisclosureThe following authors disclosed financial relationships relevant to this publication: P. Saxena: consultant to Boston Scientific; research support from Cook Medical. M. A. Khashab: consultant to Boston Scientific; consultant to Olympus America; research support from Cook Medical. The other author disclosed no relationships relevant to this publication. We read with interest the letter by Rubin and Goeppinger1Rubin D.T. Goeppinger S.R. Initial experience of a through-the-scope balloon device for ileal intubation in Crohn's disease.Gastrointest Endosc. 2013; 78: 669-670Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar in the October issue of Gastrointestinal Endoscopy regarding their experience with the NaviAidAB through-the-scope balloon (Smart Medical Systems, Ra'anana, Israel). We have also found this device useful to facilitate assessment of the distal ileum in patients with suspected Crohn's disease. To date, we have performed 24 retrograde enteroscopies using this platform, 3 for the diagnosis and management of suspected ileal Crohn's disease. We agree that no specialized training is required and that the learning curve is swift. We wish to emphasize that an adult colonoscope is necessary because the through-the-scope balloon requires a minimum working channel diameter of 3.7 mm. A concern in our early experience was advancing the balloon catheter in a blind fashion in patients with a potentially inflamed and friable ileal mucosa. However, because of the soft tip and flexible nature of the balloon catheter, we found that resistance was easily discerned. If excessive force was used to advance the balloon catheter, it would simply retroflex. Initial concerns also included blind inflation of the balloon when it was inadvertently placed within a stricture, resulting in unintended dilatation and possible perforation. However, the pressure-sensitive balloon appears to recognize the stenosis, and inflation does not occur. In our experience, the endoscope was surprisingly able to maintain a stable position during the advancement of the deflated balloon catheter without losing the ground gained. This resulted in challenging therapeutic interventions being performed (eg, polypectomy, enteral stent insertion) with standard accessories by using the larger working channel that accompanies the adult colonoscope as compared with the enteroscope. Another benefit over standard deep enteroscopy platforms is the ability to intubate the ileocecal valve by using the inflated balloon to pull the colonoscope into the terminal ileum. This may overcome a frustrating and challenging step in ileocolonoscopy.2Mehdizadeh S. Han N.J. Cheng D.W. et al.Success rate of retrograde double-balloon enteroscopy.Gastrointest Endosc. 2007; 65: 633-639Abstract Full Text Full Text PDF PubMed Scopus (66) Google Scholar DisclosureThe following authors disclosed financial relationships relevant to this publication: P. Saxena: consultant to Boston Scientific; research support from Cook Medical. M. A. Khashab: consultant to Boston Scientific; consultant to Olympus America; research support from Cook Medical. The other author disclosed no relationships relevant to this publication. The following authors disclosed financial relationships relevant to this publication: P. Saxena: consultant to Boston Scientific; research support from Cook Medical. M. A. Khashab: consultant to Boston Scientific; consultant to Olympus America; research support from Cook Medical. The other author disclosed no relationships relevant to this publication. Initial experience of a through-the-scope balloon device for ileal intubation in Crohn's diseaseGastrointestinal EndoscopyVol. 78Issue 4PreviewIntubation 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. Full-Text PDF