Clinical Scenarios for Airless Endoscopy
In the Hospital setting:
1. With patients who have cardio-pulmonary compromise and when any abdominal distention is undesirable.
2. With patients who present with super-distended colons (Ogilvie’s syndrome, sigmoid volvulus) who required decompression.
3. With any patients with active lower GI bleeding, without the prep. The VB helps to see natural distribution of fresh vs old blood throughout the colon and small bowel to determine anatomical areas from which the bleeding occurs (use double channel colonoscope if available).
4. When encountering active upper GI bleeding, or suspected variceal bleeding. In these cases, use a double channel scope, utilizing the 3,2-mm channel for the VB. When EGD has been started in a standard fashion, but large pools of blood are found, the scope should be withdrawn. Reintroduce the scope with VB and a pre-loaded Daisy cap into the stomach. Pools of blood/clots can be displaced with the balloon and the wall examined UNDER the blood clots. The second channel is then used for the therapeutic device while the pumping vessel can be tamponade by pressing against it with the VB.
5. For patients with perforated viscus, when any contaminated spillage is contraindicated, airless intubation with the VB and Daisy or Olympus attachment is desirable.
6. For patients with intestinal obstructions (small bowels or colonic) when upper GI lavage is contraindicated. Two 1-liter enemas before the colonoscopy should be performed. Use the VB and 3 Daisy caps (a double channel scope for extensive water jet use is preferable but not mandatory).
7. For small bowel DBE or SBE procedures, 3 Daisy caps on the overtubes can be used in such procedures.
In the ambulatory center:
1. With patients who have a history of prolonged procedures due to conditions such as a very redundant or twisted colon, or a fixated sigmoid. In these cases, use the VB and 3 Daisy caps pre-loaded before the procedure (see website demonstration).
2. With morbidly obese patients on whom any external maneuvers (like rotating the patient or applying external pressure) would be very difficult if not impossible.
3. For patients with borderline respiratory status in whom abdominal distention is not desirable. Also, for patients with compromised cardiac status, to avoid bradycardia, use VB and 3 Daisycuffs.
4. During standard colonoscopy, when encountering a sharply angulated left colon (sigmoid or descending colon), or fixated sigmoid colon. The insufflated air should be suctioned as much as possible and the scope should be withdrawn. Restart the procedure in airless fashion using the VB and 3 Daisy caps.
Using the “blanched vs non-blanched segments”, per the video as a guide where to turn the tip, use frequent in and out movements to pleat some of the angulation onto the balloon. Then traverse the angulated area and finish intubation with the VB again, using frequent in’s and out’s.
5. When endoscopist cannot reach the cecum during the standard colonoscopy due to redundant colon (which the endoscopist did not know about beforehand). The patient could be offered to be discharged on clear liquids, no prep, AND come back next morning for airless colonoscopy using the VB and 3 (or more) Daisy caps.
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