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.
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.
- 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.
- 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.
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.