feasibility testing of a novel device (“esp”) to improve
TRANSCRIPT
Feasibility Testing of a Novel Device (“ESP”) to Improve Endoscopic Stabilization and Visualization.S. K. Sharma, A. Datta, A. Nyugen, C. Dillon, L. Lefevbre, J. F. Cornhill and J. W. Milsom
Minimally Invasive New Technologies Group (MINT) New York Presbyterian Hospital and Weill Cornell Medical
College, New York, New York.IntroductionFlexible endoscopy is the primary diagnostic and therapeutic tool in digestive disease.
10-14 million colonoscopies performed annually [1]
Gold standard for detection and prevention of colorectal cancer [2]
Mucosal surface area visualized is considered a primary factor, accounting for the varied outcomes reported in colonoscopy [3, 4]
Endoluminal treatment approaches may ultimately replace traditional surgery[5]
Challenges
The Solution: “ESP”
Methods
Results
Next Steps
Conclusions
Endolumenal Surgical Platform (ESP): developed to meet these challenges.
Novel double-balloon endoscopic add-on device We measured the following variables
with and without ESP added to the colonoscope.
• Reaching caecum in the Kyoto-Kagaku Model (KKM).
• Time to reach caecum of KKM.• Migration of colonoscope –
centimeter (cm) slip of colonoscope.
• Surface area visualization change cm2 with % change.
• Insufflation time to a level deemed acceptable to the operating
clinician.
ESP device use did: • not affect functionality of
endoscope.• Significantly decrease colonoscopic migration
• significantly increase mucosal surface area visualised.
• significantly reduce time taken to reach clinically acceptable
visualization
- Lack of stability- Poor visualization
Variable Colonoscope Colonoscope + ESP (* = p<0.05)
Intubated Caecum (%) 100 100
Time to reach caecum (sec) 38 47*
Colonoscope Migration (cm)
60 0*
Surface Area Visualized (cm2)
34 (straight)39 (flexure)
50 (both)*
Time for maximum visualization (sec)
35 (straight)57 (flexure)
19 (straight)*35 (flexure)*
Straight segment
Flexure segment
Colonoscope Colonoscope + ESP
Validate results in-vivo.
Evaluate therapeutic application benefits
Kyoto-Kagaku Model with customized model colon
1. Zauber AG, Winawer SJ, O'Brien MJ, Lansdorp-Vogelaar I, van Ballegooijen M, Hankey BF, et al. Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths. The New England journal of medicine. 2012;366(8):687-96. Epub 2012/02/24.2. Seeff LC, Richards TB, Shapiro JA, Nadel MR, Manninen DL, Given LS, et al. How many endoscopies are performed for colorectal cancer screening? Results from CDC's survey of endoscopic capacity. Gastroenterology. 2004;127(6):1670-7. Epub 2004/12/04.3. Anderloni A, Jovani M, Hassan C, Repici A. Advances, problems, and complications of polypectomy. Clinical and experimental gastroenterology. 2014;7:285-96. Epub 2014/09/12.4. Samadder NJ, Curtin K, Tuohy TM, Pappas L, Boucher K, Provenzale D, et al. Characteristics of missed or interval colorectal cancer and patient survival: a population-based study. Gastroenterology. 2014;146(4):950-60. Epub 2014/01/15.5. Sharma SK, Milsom JW and Yoo J. Can endoscopy and laparoscopy be combined to remove complex polyps? Colorectal Cancer. 2013;2(6):479-82.
References
Colonoscope
ESP
Despite the importance and versatility of flexible endoscopy challenges in it’s execution still exist
Colonoscope view