Depth of Maximal Ileal Insertion During Retrograde Enteroscopy With TTS Balloon
Depth of Maximal Ileal Insertion During Retrograde Enteroscopy With TTS Balloon
Diagnostic modalities for the evaluation of small bowel pathology include video capsule
 endoscopy (VCE), antegrade and retrograde device-assisted enteroscopy, CT and MR enterography
 (1). Despite VCE being the first-line evaluation modality, it lacks interventional
 capability. Deep enteroscopy (DE) allows tissue sampling and other therapeutic interventions
 with real-time endoscopic assessment. DE is usually performed with specific endoscopes
 (balloon-assisted device or spiral overtube) making it time consuming and there is limited
 availability since special instruments and accessories are required.(1,2) The
 through-the-scope (TTS) balloon system consists of a balloon catheter designed for anchoring
 in the small bowel, inserted through the instrument channel of a standard colonoscope.(3) The
 catheter is advanced, the balloon is inflated and anchored in the small intestine and the
 endoscope slides over the guiding catheter to the inflated balloon. The most common
 indications for DE are obscure GI bleeding, iron deficiency anemia, abnormal capsule
 endoscopy and chronic diarrhea. As compared to spiral, single-or double-balloon enteroscopy,
 TTS (NaviAid, SMART Medical Systems Ltd, Ra'anana, Israel) is a simpler technique, which
 requires less investment in infrastructure. The balloon catheter is advanced blindly in front
 of a standard adult colonoscope as it bends around the curves of the small bowel. To prevent
 perforation/trauma the catheter is fitted with a soft silicone tip which easily bends under
 pressure.

 Insertion depth can be calculated during the withdrawal of the enteroscope. The Aim of the
 study: To compare the depth of maximal ileal insertion between through-the-scope balloon
 enteroscopy (NaviAid) with enteroscopy using the adult colonoscope (Olympus CF-190) alone, in
 the same patient, in a prospective cohort at University Medical Center of El Paso, Texas.
The Aim of the study: To compare the depth of maximal ileal insertion between
 through-the-scope balloon enteroscopy (NaviAid) with enteroscopy using the adult colonoscope
 (Olympus CF-190) alone, in the same patient, in a prospective cohort from August 1, 2020 to
 July 31, 2023 at University Medical Center of El Paso, Texas.

 Depth of insertion is correlated with diagnostic yield, meaning that we would like to
 ascertain if the use of the colonoscope with NaviAid will result in greater depth of
 insertion and potentially more findings of small bowel abnormalities than using a colonoscope
 alone.

 It is assumed that this is the case, but we want to show it and quantify it.

 HYPOTHESIS:

 The depth of ileal insertion is greater with the use of through-the-scope balloon enteroscopy
 (NaviAid) when compared with enteroscopy using the standard adult colonoscope (Olympus
 CF-190) alone.

 OBJECTIVE:

 To compare the depth of maximal ileal insertion between through-the-scope balloon enteroscopy
 (NaviAid) with the adult colonoscope (Olympus CF-190) alone, in the same patient, in a
 prospective cohort at University Medical Center of El Paso, Texas.
Inclusion Criteria:

 1. Sign Informed Consent Form

 2. Patients age between 18-90 years

 3. Patients in which retrograde enteroscopy is indicated for any of the following:

 abnormal video capsule endoscopy non-diagnostic upper and lower endoscopy obscure
 gastrointestinal bleeding iron deficiency anemia non-diagnostic upper endoscopy and
 abnormal CT Hemodynamically stable

 Exclusion Criteria:

 1. Inability to sign Informed Consent Form

 2. Pregnancy and breast feeding

 3. Prior colon resection

 4. Patients with known strictures

 5. Patients with altered anatomy

 6. Inadequate bowel preparation.