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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7732720PMC
http://dx.doi.org/10.1016/j.vgie.2020.08.003DOI Listing

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Subepithelial lesions in the gastrointestinal tract present diagnostic challenges, particularly in difficult-to-access regions like the cecum. This case report describes a 71-year-old woman with a submucosal lesion adjacent to the appendix, where a rigidizing overtube was used to stabilize the colonoscope for an endoscopic ultrasound-guided fine-needle biopsy. The procedure was successful, obtaining a benign diagnosis without the need for surgery.

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Background: A novel rigidizing overtube (ROT) was developed to facilitate endoscopic removal of complex gastrointestinal polyps. We aimed to prospectively evaluate the efficacy and safety of the device in the management of large gastrointestinal polyps.

Methods: A prospective, single-center study, conducted between May 2021 and April 2023, enrolled patients undergoing endoscopic resection of colon/duodenal polyps ≥25 mm.

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Strategies to manage the difficult colonoscopy.

World J Gastrointest Endosc

July 2023

Department of Gastroenterology, Stanford University Medical Center, Palo Alto, CA 94306, United States.

During endoscopy, an endoscopist is inevitably faced with the occasional "difficult colonoscopy," in which the endoscopist finds it challenging to advance the endoscope to the cecum. Beyond optimization of technique, with minimized looping, minimal insufflation, sufficient sedation, and abdominal splinting when needed, sometimes additional tools may be needed. In this review, we cover available techniques and technologies to help navigate the difficult colonoscopy, including the ultrathin colonoscope, rigidizing overtube, balloon-assisted colonoscopy and the abdominal compression device.

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Video 1Endoscopic video demonstrating the ability to gain access to the biliary system using the rigidizing overtube, and subsequent attempted EMR of the neoplastic lesion, followed by successful APC with complete ablation of the neoplasm.

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