P0165 - Enhancing Colonoscopy Outcomes: A Systematic Review of the Clinical Effectiveness of a Novel Rigidizing Overtube in Completing Difficult Colonoscopies and Achieving Complex Polyp Resection

Eleazar E.. Montalvan-Sanchez, MD¹, Shajan Peter, MD², Sergio A. Sánchez-Luna, MD², Renato Beas, MD³, Azizullah Beran, MD³, Douglas Morgan, MD, MPH⁴, Dalton A. Norwood, MD^5
1Indiana University School of Medicine, Indianapolis, IN; ²Basil I. Hirschowitz Endoscopic Center of Excellence, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL; ³Indiana University, Indianapolis, IN; ⁴University of Alabama at Birmingham, Birmingham, AL; ⁵UAB Minority Health and Health Equity Research Center, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL

Introduction: Poor scope maneuverability and loop formation are some of the reasons for incomplete colonoscopies and suboptimal polyp resection even amongst expert endoscopists. The rigidizing overtube (RO) has been reported as a useful device used to overcome difficulties during colonoscopies and assisting in the completion of technically challenging procedures. In this study, we conducted a systematic review to assess the clinical success of using the RO to complete difficult colonoscopies and achieve complex polyp removal.

Methods: We used multiple electronic databases from August 2019 through May 2023 to identify studies evaluating the use of the novel RO for colonoscopies. We followed the PRISMA guidelines. Quality/risk for bias was assessed using the Newcastle-Ottawa Scale (NOS).

Results: Six studies were included; one study was divided into two different indications with a total of 165 patients (Figure). In the 3 studies that the indication was difficult to complete colonoscopies involving (53 patients), the colonoscopy completion rate was 88.7% (n=47), the procedure facilitation was reported in 2/3 studies with a 93.1% (n=27) and 100% (n=9) respectively. Failure in these studies were reported in 2 patients due to anatomical restrictions and no adverse events were reported. One study compared polyp resection with and without the RO, reporting similar en-bloc resection and curative rates using RO (RO-ESD) when compared with conventional ESD (C-ESD), en-bloc resection success (RO-ESD 92% vs 96% C-ESD) and curative resection (RO-ESD 88% vs 92% C-ESD). In 2 studies that evaluated RO in the removal of complex polyps (62 patients), technical success was achieved 100% for both studies. One of the studies reported clinical success of 90% (n=52), en-bloc resection of 86.4% and R0 resection of 80%, for both studies procedure facilitation ranged from 98.3-100%. None of these studies reported adverse events (Table).

Discussion: Our findings suggest that using RO shows promise in enhancing the clinical success of completing difficult colonoscopies and achieving successful ESD and EMR of colonic lesions by avoiding looping and offering stability. Further randomized studies evaluating the efficacy and cost of the RO are warranted.




Disclosures:


Eleazar E.. Montalvan-Sanchez, MD¹, Shajan Peter, MD², Sergio A. Sánchez-Luna, MD², Renato Beas, MD³, Azizullah Beran, MD³, Douglas Morgan, MD, MPH⁴, Dalton A. Norwood, MD⁵. P0165 - Enhancing Colonoscopy Outcomes: A Systematic Review of the Clinical Effectiveness of a Novel Rigidizing Overtube in Completing Difficult Colonoscopies and Achieving Complex Polyp Resection, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.