Diverse endoscopic applications of a novel dynamic rigidizing overtube. A novel dynamic rigidizing overtube is now available to help with challenging colonoscopies in long, looping colons. This device also has been shown to have applications beyond challenging colonoscopy. It may be beneficial in select cases for stabilization during complex polypectomy, assisting with ERCP in post-surgical anatomy, and retrograde and endoscopies. This is the overtube in its flexible state. When suction is applied, it becomes 15 times more rigid. It is completely pliable in its flexible state. When the endoscope is in the overtube, there is an increase in stability at the endoscopy tip and an improvement in the one-to-one movement. In this case, we have a 72-year-old male who presented for surveillance colonoscopy. The colonoscope was advanced to the ascending colon, but it could not be advanced further due to loop formation. Every time the scope looped, the patient became bradycardic with a heart rate in the 40s, presumably from a vasovagal reflex. Despite abdominal counterpressure and positional change, attempts at advancing the colonoscope were unsuccessful due to looping and bradycardia. Here you can see paradoxical movement with the scope insertion. Even with abdominal counterpressure applied, we were unsuccessful in reaching the cecum. As a result, we decided to prepare the rigidizing overtube. We prepared it by inserting approximately 50 cc of water into the tube lubin and lubricated it for 30 seconds. We mounted the overtube on the pediatric colonoscope and fixed it at the scope hub. We then advanced the scope as far as we could to about 80 cm of insertion where the loop was starting to form. Then, we advanced the overtube like a catheter over a guide wire until the entire overtube was in the colon. We turned on the tube suction and the overtube rigidized instantly. The scope was unable to advance easily past the point of the looping where we were stuck before. However, close to the cecum, there was another loop encountered. At this point, the overtube was made flexible and then the scope and the overtube together were reduced by about 25 cm. The overtube was then advanced further up the scope and rigidized and the scope was then easily able to be advanced into the cecum. Our second case is an 85-year-old male presenting for endoscopic mucosal resection of a large descending colon polyp with prior attempts by an outside interventionist who failed to complete polypectomy. The overtube was used to assist in stabilizing the scope tip and performing underwater EMR of the lesion. The overtube was rigidized and, as you can see, we were able to obtain excellent tip control for visualization of the lesion. Furthermore, there was excellent tip control for underwater resection of the lesion and stabilization for bleeding therapy. Final views show a clean polyp base without residual lesion. Our third case is a 75-year-old male presenting for endoscopic mucosal resection of a large descending colon polyp with prior attempts by an outside interventionist who failed to complete polypectomy. The overtube was rigidized and the scope tip was rigidized and the scope tip was As you can see, the endoscope was easily advanced deep into the ileum. Here on Withdrawal, you can see the extent to which the scope reached. There was excellent stabilization on withdrawal. In conclusion, this novel dynamic rigidizing overtube has the capability to assist with multiple endoscopic procedures beyond challenging colonoscopy. It is adept at providing stability during both antegrade and retrograde interventions, potentially reducing anesthesia time and overall procedure risk, as well as mental and physical demand of the endoscopist.

dynamic rigidizing overtube

endoscopic applications

flexible overtube

suction-induced rigidity

benefits in colonoscopies