D0095 - Improving Suboptimal Bowel Prep in a Hydraulically Sealed Endoluminal Compartment Using a Novel On-Demand Overtube Device: An in vivo Animal Study

Introduction: Inadequate bowel preparation during colonoscopy results in increased cost and risk to the patient due to need for additional examinations, reduced diagnostic yield, and increased the risk of subsequent colorectal cancer. A recently developed novel overtube (OT) device (IzoScope™, IzoMed Inc., Irvine, CA) can safely and efficiently seal a compartment of the colon and administer targeted fluid lavage (e.g., right colonic enema). The aim of this study was to describe the use of this device to address segmental suboptimal bowel preparation and improve visibility during colonoscopy.

Case Description/Methods: We performed a proof-of-concept study using a single domestic pig. The right colon was intubated using a standard adult colonoscope, and poor bowel preparation was seen with opaque liquid and stool precluding the visualization of the mucosa, consistent with a Boston Bowel Preparation Scale (BBPS) subscore of 0 (Fig.1A). The OT device was then deployed. The device consists of a soft, flexible sheet that can be quickly wrapped around the colonoscope, essentially creating an on-demand OT without need for preloading or scope withdrawal. The device deploys a balloon on the end of the OT, behind the tip of the endoscope, to create an anchor for the OT in the colon (Fig.1B, arrow). A second balloon on a catheter extends beyond the endoscope and can be used to seal the end of the compartment (Fig 1B, arrowhead). The balloons were used to create a sealed, compartment in the right colon that maintained an access for the OT after withdrawal of the endoscope. Fluid was then instilled through the OT (Fig.1B, star) to effectively perform a right colonic enema. One liter of normal saline was lavaged into the right colon and drained via gravity. The distal balloon catheter was then withdrawn to provide additional cleansing through a “squeegee”-like effect (Fig.1C). The colonoscope was then reinserted and mucosa was inspected. Bowel preparation had markedly improved, consistent with a BBPS subscore of 3 (Fig.1D).

Discussion: Using a novel OT device presented here, we were able to improve segmental bowel preparation, particularly at the right colon which is not typically accessible to conventional enema. The device can be used as an on-demand OT during colonoscopy to optimize mucosal visualization in suboptimal bowel preparation as shown in this study. This technology may potentially reduce the need to cancel or reschedule procedures when suboptimal preparation is encountered.