The PowerSpiral Enteroscope may be used for retrograde examination of the small bowel, which is more complex than the antegrade approach. It requires additional maneuvers, especially during the colonoscopy phase of the procedure, enlisting loop reduction, manual abdominal compression, and passage through the ileocecal valve.
Entering the Colon
Stalling during sigmoid passage may indicate increased resistance. After a loop reduction effort, resume slow spiral forward motion. Use water irrigation for both lubrication and distention of the lumen.
Looping may also occur within the transverse colon. The same technique, withdrawing the enteroscope with forward rotation of the spiral segment, as used in the sigmoid, is also used in this location. The principal is to minimize the amount of scope inserted in the colon thereby preserving as much scope length as possible with which to examine the small bowel.
Passing through the ileocecal valve
Passing through the Small Bowel
When the passage is stalling, there should be attention paid to the force gauge, especially if the limit stop function is activated and rotation of the spiral segment stops automatically. This indicates significant resistance against the bowel wall and further rotational advancement could lead to an adverse event.
With rotation of the spiral segment stopped, use water irrigation to lubricate the small bowel. Manual abdominal compression is then applied and passage with forward rotation of the spiral segment is resumed after first reducing any loops.
Withdrawal after maximal retrograde insertion
Maximal retrograde insertion can be recognized when further advancement stops despite the maneuvers described previously, if a tattoo placed during a prior integrate enteroscopy is seen, or the duodenum is identified.