3 6 S U P P L E M E N T T O O U T P A T I E N T S U R G E R Y M A G A Z I N E A P R I L 2 0 1 5
Flattened folds
Mechanical innovations are also being created to give physicians a little help
during scope extubation. New single-use smoothing devices are becoming
more popular as a way to manually give doctors a more complete view of
the colon.
Currently, there are 2 technologies available in the U.S. that attach to the end
of your existing colonoscopes to flatten the colon, improving mucosal vision
and enhancing tip control.
The first is a single-use cap with soft fingers that remain flush to the device as
you advance the scope through the colon, so forward motion isn't hindered.
Once you reach the cecum and begin extubation, the soft fingers open and
catch the colon wall. The cap everts large folds and flattens small folds, allow-
ing you to catch a glance of the other sides as you move the scope. The other
disposable device has a similar approach, but uses 3 discs instead of soft fin-
gers.
These devices are based on a simple concept, but can be very effective in let-
ting you see behind each fold in the colon in order to catch more polyps. As
with panoramic views, these mechanical devices have shown some promise in
clinical trials to minimize missed adenomas. Another secondary benefit to keep
in mind is that these devices can help support the tip of the colonoscope during
extubation, providing greater stability and reducing looping.
While the 2 cap devices are the only ones available in the U.S., another tech-
nology currently being used in Europe uses a balloon to help physicians see
behind the folds. The physician partially inflates the balloon during extubation,
which smooths and straightens the folds, allowing for enhanced polyp detec-
tion. Compared with the cap devices, the balloon would let you see a larger seg-
ment of the colon at one time and could also be inflated to anchor and stabilize
the endoscope during intervention. It's not currently available in the U.S., but
could come stateside soon.
