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General Techniques

  • If no further advancement is achieved after employing supplemental maneuvers, it should be interpreted as a warning to assess the patient and scope position.

  • In the case of continued rotation without advancement after 5-10 seconds, or repeated activation of the automatic stop function, the user should try to resolve the issue using loop reduction, manual abdominal compression, decompression, water insufflation or other maneuvers.

  • The limit function does not guarantee patient safety during the procedure. The operator must judge if safe insertion can be continued on a case-by-case basis.

What is the limit function?
A

The limit function stops the rotation of the spiral segment when the resistance to rotation reaches a certain limit. To reset, remove your foot from the pedal on the foot switch. Depressing the pedal again will restart the rotation function. 

Insertion Tips

  • Gentle forward pressure is applied to the enteroscope when rotation is started to advance.
  • Minimize CO2 insufflation.
  • Irrigation using water jet may help with lumen visualization and lubrication.
  • Intermittent manual abdominal compression and release is often helpful to facilitate engagement of the bowel to the spiral segment and facilitate advancement.

Withdrawal Tips

  • Insufflation may be used as needed at this time.
  • Slow controlled withdrawal is the key. This is accomplished by backward rotation while maintaining the scope position and keeping the tip in motion.

Note


PowerSpiral Enteroscpy is a fundamentally different technique than ballon-assisted enteroscopy and relies on passive pleating and unpleating of bowel. Forceful advancement or withdrawal should not be used with PowerSpiral Enteroscopy.