Applications in the Large Intestine Other than Technically Difficult Cases

For endoscopic treatment in the large intestine, holding the endoscope in an ideal position is essential but sometimes difficult depending on the site of the lesion. It is particularly difficult around the hepatic flexure, splenic flexure, and sigmoid colon-descending colon junction, and its failure precludes the delicate manipulation needed for endoscopic treatment. With colonoscopy, the colonoscope is manipulated distally from fixed points, such as the anus, sigmoid colon-descending colon junction, splenic flexure, and hepatic flexure, from outside of the body. The more distant the colonoscope tip is placed from the fixed point, the more difficult is the manipulation. With double-balloon endoscopy, a stable fixed support can be established in any place by holding the intestine with the balloon at the tip of the overtube. This allows delicate manipulation and safer endoscopic treatment even in areas where the conventional endoscope is difficult to manipulate.

In the presence of multiple large polyps that cannot be suctioned through the forceps channel in the distal portion of the large intestine, it may be troublesome to collect resected specimens after endoscopic polypectomy. With conventional colonoscopy, multiple resected polyp specimens may be collected with a five-nail forceps or a net at a time. However, if it is difficult, each resected polyp specimen should be grasped with a five-nail forceps, and the endoscope should be removed for collection and then reinserted to repeat the polypectomy. With double-balloon endoscopy, the endoscope can be removed, leaving the overtube with balloon attached in the deep portion of the large intestine. Thus, the endoscope tip can be placed back into the same position of the large intestine in a few seconds through the overtube after the endoscope is removed to collect each resected specimen. When endo-scopic polypectomy is performed during technically challenging colonoscopy, this characteristic provides a significant advantage together with the aforementioned improved maneuverability of the endoscope.

Decompression with a long decompression tube inserted through the anus may be required in the bowel obstruction of the large intestine because of advanced colorectal cancer. A guidewire is usually inserted through the forceps channel of the colonoscope, which has been inserted into the affected region, so the tip of the wire is placed beyond the affected region. After removing the colonoscope, a dilator is inserted along the guidewire to dilate the stenosis, followed by insertion of a long decompression tube along the guidewire through the anus. When the affected region is localized in either the transverse or ascending colon, however, it may be difficult to insert a long decompression tube through the anus because the guidewire bends on the way. In such cases, placing the overtube with balloon attached near the affected region facilitates inserting a long decompression tube through the anus (Fig. 12.1.7).

As described above, in patients in whom insertion of a colonoscope is difficult, double-balloon endoscopy is extremely useful for inhibiting stretching of the intestine, substantially reducing patient discomfort, and allowing easy insertion and manipulation of the endoscope. These advantages are useful not only for challenging, but also routine, colonoscopy. Although colonoscopy has become popular now, extensive training is required to be an endoscopist capable of performing colonoscopy without discomfort to the patient. Because of the lack of skilled endoscopists in some regions, colonoscopy causes significant discomfort to patients. Double-balloon endoscopy is expected to help resolve such problems.

Endo Decompression Tube
Fig. 12.1.7. Insertion of a long decompression tube through the anus
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