Jacqueline Rampy, MD1, Leon Kundrotas, MD, MS2; 1UTHSCSA, San Antonio, TX; 2Audie L. Murphy VA Hospital, San Antonio, TX
Introduction: Satisfactory endoscopic visualization of colonic or small bowel mucosa can be a challenge through an existing ostomy as adequate luminal insufflation is difficult due to air escape around the port of entry. We present an easy to use and simple technique for luminal insufflation using a standard powder-free nitrile exam glove as an aide to provide a relatively constant positive pressure during endoscopy through an ostomy site.
Methods: A standard powder-free nitrile exam glove is used. The size of the glove (large, medium or small) is determined by the size of the patient's ostomy site appliance. The tip of the third finger of the glove (approximately half way down the digit) is removed. The base of the glove is stretched over the plastic ostomy appliance to create a seal. The endoscope is inserted through the cut tip of the exam glove and into the ostomy opening with direct and endoscopic visualization. The ostomy site is intubated and air introduced by the endoscope is used to keep the lumen of the bowel insufflated through the use of positive pressure. This maintenance of insufflation of the bowel lumen allows advancement of the endoscope by luminal distention for direct visualization and provides direction for further intubation. Discussion: This simple technique has been used on several of our patients with large or small bowel ostomies to provide sufficient luminal insufflation for enhanced mucosal visualization and advancement of the endoscope. In addition, it provides a barrier to reduce retained luminal content splatter. The positive pressure created can be controlled by suction through the endoscope or by loosening the stretched portion of the finger on glove around the endoscope. Our subjective evaluation of this technique in 5 patients gave superior mucosal visualization of the target bowel mucosa when compared to using the standard techniques. This simple and easy to use technique is not only safe, but it is cost-effective as well. We believe this practice yields the best mucosal exam of the bowel lumen possible with ease of progressive intubation by the endoscope to the targeted extent of the examination.
Endoscope passes through the tip of one of fingers on the exam glove to create a relative seal for positive pressure insufflation
Insufflated exam glove over ostomy site with tight fit over appliance transmitting positive pressure to the enterostomy below with endoscopic intubation
Disclosures: Jacqueline Rampy indicated no relevant financial relationships. Leon Kundrotas indicated no relevant financial relationships.