EXTREME ENDOSCOPY: A NEW PARADIGM IN THERAPEUTIC ENDOSCOPY

Aims:

Previous data on extreme endoscopy comes from case reports.

To report on the feasibility and outcomes of extreme endoscopy in a large center.

Methods:

Observational, single-center, cohort retrospective study during an 18-months period. Extreme endoscopy comprises five key elements:

1. use of multiple scopes or dual endoscope technique;

2. use of various types of overtubes (OT),

3. utilization of modified devices,

4. use of fluoroscopy and,

5. necessity of utilizing a tool box with: wire cutter, glue, tape, foam (e.g. Endosponge). Exclusion: traditional double balloon-enterosopy or DBE ERCP, ESD.

Results:

44 patients (23 females, 21 males, mean age 57 years, range 32 – 83) with various types of complex primary, secondary or post-surgical anatomy endoluminal GI defects were studied. In 20 patients (45%) previous surgical, endoscopic or radiologic attempts at solving the problem had failed. In 11 patients (25%) there were no other interventional treatment options available. Interventions performed: PATENT (n = 3), endoscopic re-anastomosis of the disrupted GI tract (n = 4), Endosponge placement for drainage of huge cavities (n = 3), OT-assisted removal of mesh (n = 2), OT-assisted removal of migrated lap bands (n = 3), OT-assisted SEMS placement of the small bowel and/or colon (n = 8), combined closure of fistula or perforation and placement of direct endoscopic jejunostomy (n = 7), other (n = 9). The technical success was 87.8%. The mean procedure time was 35 minutes (range 45 min to 4 hours). There were no major adverse events associated with the procedures.

Conclusions:

This is the largest study reporting on extreme endoscopy. Albeit time consuming, extreme endoscopic interventions lead to a resolution or remedy of complex endoluminal disorders in the majority of patients with low complication. It appears that extreme endoscopy may provide hope for patients in whom no other choices exist.