Internal Medicine Resident University of California Irvine Larchmont, NY
Alexander Abadir, MD1, Nathan Park, MD2, David J. Eng, MD3, Nabil El Hage Chehade, MD4, Jason Samarasena, MD2; 1University of California Irvine, Larchmont, NY; 2University of California Irvine, Orange, CA; 3University of California Irvine Medical Center, Orange, CA; 4University of California Irvine Medical Center, Cleveland, OH
Introduction: Looping colons challenge endoscopists, prolong anesthesia, and limit examination and therapy. Failure due to a looping colon results in suboptimal patient care and causes mental and physical fatigue on the endoscopist. A novel rigidizing overtube is now available to reduce looping and facilitate colonoscopy completion. In its flexible state, the overtube material is soft and pliable; in its rigid state it becomes fifteen times stiffer, aiding in stability and minimizing loop formation. In this study, we examine if a rigidizing overtube can salvage colonoscopies previously terminated due to challenging looping of the colon and reduce the overall perceived workload. Methods: This is a prospective single center experience over a 6 month period using a novel dynamic rigidizing overtube for assistance during difficult colonoscopy. Difficult colonoscopy subjects were categorized as based on: looping that prevented reaching the cecum despite position change and abdominal counter pressure (LOOP group) or poor stabilization to perform therapeutic polypectomy (UNSTABLE group). Parameters assessed included successful/failed salvage of the procedure, and the in-procedure NASA Task Load Index (TLX) before and after use of the rigidizing overtube. The TLX raw and weighted scores were compared for each type of demand (mental, physical, effort, temporal, performance and frustration). Results: Over the study period, there were 14 difficult colonoscopy procedures 8 in the LOOP group and 6 in the UNSTABLE group. In the LOOP group, all 8 cases were salvaged, and cecum was reached after device was used. The TLX weighted score decreased from 81.1 to 26.0 after use (p< 0.01). In the UNSTABLE group, complete polypectomy was successful in all cases. The TLX weighted score decreased from 79.7 to 40.4 after use (p< 0.01). In all procedures, the TLX raw scores for each type of demand was reduced (Figure 1; all p< 0.05). Discussion: In this early series, a novel dynamic rigidizing overtube was able to successfully assist in salvaging difficult colonoscopy due to looping and assist in complex polypectomy by improving stabilization. In addition, the endoscopist’s in-procedure perceived workload significantly decreased after use of the device. This novel rigidizing overtube has potential to help salvage difficult endoscopic cases as well as decrease the workload of the endoscopist during difficult procedures.
Image of the rigidizing overtube. The overtube is placed at the hub of the colonoscope, allowing free tip movement. When the vaccum is applied, the normally flexible overtube becomes fifteen times as rigid, allowing 1 to 1 movement when force is applied to the shaft of the colonoscope.
Means of raw NASA-TLX demand scores before and after use of the rigidizing overtube in difficult colonoscopies. All score changes were statistically significant
Disclosures: Alexander Abadir indicated no relevant financial relationships. Nathan Park indicated no relevant financial relationships. David Eng indicated no relevant financial relationships. Nabil El Hage Chehade indicated no relevant financial relationships. Jason Samarasena: Neptune Medical – Consultant.