Retrieval of dislodged AmplifEYE using balloon dilator during colonoscopy

Retrieval of dislodged AmplifEYE using balloon dilator during colonoscopy AmplifEYE can increase the detection rate of adenomatous polyps and stabilize the mucosa for easy biopsy and polypectomy. But it can also become a foreign body when it is dislodged during the procedure. We report a case of dislodged AmplifEYE during colonoscopy that was successfully retrieved using a balloon dilator. colonoscopy, AmplifEYE, foreign-body retrieval, balloon dilator Introduction The AmplifEYE (Medivators Inc., Minneapolis, MN) is a product to increase the rate of adenomatous polyp detection. It has flexible arms that can separate folds and gently stretch the mucosa to provide a clear view of the lumen, bringing polyps, including those behind the folds, into view. A dislodged AmplifEYE as a foreign body within the colon may be passed automatically with a bowel movement. But it may also raise speculation and cause complications as a retained medical device. Case presentation A 54-year-old female patient was referred by a primary care physician for colonoscopy. She had chronic diarrhea and was found to have positive occult blood in stools. She also had a family history of colon polyps. Colonoscopy was performed under sedation with monitored anesthesia care. The AmplifEYE was placed over the tip of the scope before the procedure. The insertion was smooth. Withdrawal of the scope was also otherwise uneventful, but the AmplifEYE dislodged within the sigmoid colon. The site was at 25 cm marked by the scope. Retrieval was attempted with different approaches. Biopsy forceps were tried, which were able to hold the edge at the back of the AmplifEYE, but fell off immediately when pulled. The strength of the forceps was not able to overcome the resistance from the colon mucosa. We then attempted to flip the AmplifEYE to let the detection arms face downward for easy grab by the forceps. Different spots on the arms were tried by the forceps, but again it fell immediately when pulled on (Figure 1). Attempts to hold the body by snares also failed. The arm was able to be held by the snare but, because of its tapering by design, it slipped off easily. When held tighter on the snare, it only cut through and amputated the arm. A basket was our next plan, but we did not have the appropriate size. Finally, a 20-mm esophageal balloon dilator was introduced within a gastroscope. It was passed through the lumen of the AmplifEYE and was inflated to hold the AmplifEYE towards the scope. They were then successfully removed as a unit (Figure 2). Figure 1. View largeDownload slide Attempt to grasp the AmplifEYE with forceps after it was flipped with the detection arms facing towards the scope. Figure 1. View largeDownload slide Attempt to grasp the AmplifEYE with forceps after it was flipped with the detection arms facing towards the scope. Figure 2. View largeDownload slide The balloon dilator was inflated to hold and align the AmplifEYE with the scope for easy retrieval. Figure 2. View largeDownload slide The balloon dilator was inflated to hold and align the AmplifEYE with the scope for easy retrieval. Discussion There are no data at the present time in the literature specific to the AmplifEYE, but a similar product, the Endocuff (ARC Medical, England), has been reported to increase the polyp detection rate by 14%, increase the number of polyps detected by 63% per patient and increase the number of adenoma detection by 86% per patient in a randomized prospective trial of 498 patients [1]. The AmplifEYE is supplied in two sizes. The small size fits a scope diameter of 11.0–12.5 mm and the large size fits a scope diameter of 12.5–13.8 mm. It is very import to use the appropriate size for different scopes. We realized after it had dislodged that a large AmplifEYE had been placed over a pediatric scope. The manifestation of a gastrointestinal foreign body varies with the type of object and location, as well as the management. The spontaneous pass rate of AmplifEYE is not known, but approximately one-third of patients with gastrointestinal foreign bodies need surgical or endoscopic procedures in a report of 7480 pediatric patients [2]. In a review of 93 cases of colorectal foreign bodies, bedside extraction was successful in 74%. In the rest of the group, 55% of patients presenting with a foreign body in the sigmoid colon required operative intervention vs 24% of patients with objects in their rectum [3]. Since this patient had a relatively narrow sigmoid colon, we decide to retrieve it to avoid speculation and the potential complication of a retained medical device. Retrieval of a dislodged AmplifEYE follows the general principles of foreign-body removal under endoscopy. We believe that the endoscopic basket is a good tool but, because of its shape, resistance by the mucosa during removal is to be expected. We recommend using a balloon dilator that aligns and holds the balloon, the AmplifEYE and the scope together, and they can be removed smoothly as a unit. Conflict of interest statement: none declared. References 1 Biecker E Floer M Heinecke A et al.  . Novel endocuff-assisted colonoscopy significantly increases the polyp detection rate: a randomized controlled trial. J Clin Gastroenterol  2015; 49: 413– 18. Google Scholar CrossRef Search ADS PubMed  2 Kennedy RS Starker RA Feldman KA et al.  . Cost varies with procedure type in pediatric GI foreign bodies. J Pediatr Surg  2016 1 September [Epub ahead of print]. 3 Lake JP Essani R Petrone P et al.  . Management of retained colorectal foreign bodies: predictors of operative intervention. Dis Colon Rectum  2004; 47: 1694– 8. Google Scholar CrossRef Search ADS PubMed  © The Author(s) 2017. Published by Oxford University Press and Sixth Affiliated Hospital of Sun Yat-Sen University This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Gastroenterology Report Oxford University Press

Retrieval of dislodged AmplifEYE using balloon dilator during colonoscopy

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Oxford University Press
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© The Author(s) 2017. Published by Oxford University Press and Sixth Affiliated Hospital of Sun Yat-Sen University
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2052-0034
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Abstract

AmplifEYE can increase the detection rate of adenomatous polyps and stabilize the mucosa for easy biopsy and polypectomy. But it can also become a foreign body when it is dislodged during the procedure. We report a case of dislodged AmplifEYE during colonoscopy that was successfully retrieved using a balloon dilator. colonoscopy, AmplifEYE, foreign-body retrieval, balloon dilator Introduction The AmplifEYE (Medivators Inc., Minneapolis, MN) is a product to increase the rate of adenomatous polyp detection. It has flexible arms that can separate folds and gently stretch the mucosa to provide a clear view of the lumen, bringing polyps, including those behind the folds, into view. A dislodged AmplifEYE as a foreign body within the colon may be passed automatically with a bowel movement. But it may also raise speculation and cause complications as a retained medical device. Case presentation A 54-year-old female patient was referred by a primary care physician for colonoscopy. She had chronic diarrhea and was found to have positive occult blood in stools. She also had a family history of colon polyps. Colonoscopy was performed under sedation with monitored anesthesia care. The AmplifEYE was placed over the tip of the scope before the procedure. The insertion was smooth. Withdrawal of the scope was also otherwise uneventful, but the AmplifEYE dislodged within the sigmoid colon. The site was at 25 cm marked by the scope. Retrieval was attempted with different approaches. Biopsy forceps were tried, which were able to hold the edge at the back of the AmplifEYE, but fell off immediately when pulled. The strength of the forceps was not able to overcome the resistance from the colon mucosa. We then attempted to flip the AmplifEYE to let the detection arms face downward for easy grab by the forceps. Different spots on the arms were tried by the forceps, but again it fell immediately when pulled on (Figure 1). Attempts to hold the body by snares also failed. The arm was able to be held by the snare but, because of its tapering by design, it slipped off easily. When held tighter on the snare, it only cut through and amputated the arm. A basket was our next plan, but we did not have the appropriate size. Finally, a 20-mm esophageal balloon dilator was introduced within a gastroscope. It was passed through the lumen of the AmplifEYE and was inflated to hold the AmplifEYE towards the scope. They were then successfully removed as a unit (Figure 2). Figure 1. View largeDownload slide Attempt to grasp the AmplifEYE with forceps after it was flipped with the detection arms facing towards the scope. Figure 1. View largeDownload slide Attempt to grasp the AmplifEYE with forceps after it was flipped with the detection arms facing towards the scope. Figure 2. View largeDownload slide The balloon dilator was inflated to hold and align the AmplifEYE with the scope for easy retrieval. Figure 2. View largeDownload slide The balloon dilator was inflated to hold and align the AmplifEYE with the scope for easy retrieval. Discussion There are no data at the present time in the literature specific to the AmplifEYE, but a similar product, the Endocuff (ARC Medical, England), has been reported to increase the polyp detection rate by 14%, increase the number of polyps detected by 63% per patient and increase the number of adenoma detection by 86% per patient in a randomized prospective trial of 498 patients [1]. The AmplifEYE is supplied in two sizes. The small size fits a scope diameter of 11.0–12.5 mm and the large size fits a scope diameter of 12.5–13.8 mm. It is very import to use the appropriate size for different scopes. We realized after it had dislodged that a large AmplifEYE had been placed over a pediatric scope. The manifestation of a gastrointestinal foreign body varies with the type of object and location, as well as the management. The spontaneous pass rate of AmplifEYE is not known, but approximately one-third of patients with gastrointestinal foreign bodies need surgical or endoscopic procedures in a report of 7480 pediatric patients [2]. In a review of 93 cases of colorectal foreign bodies, bedside extraction was successful in 74%. In the rest of the group, 55% of patients presenting with a foreign body in the sigmoid colon required operative intervention vs 24% of patients with objects in their rectum [3]. Since this patient had a relatively narrow sigmoid colon, we decide to retrieve it to avoid speculation and the potential complication of a retained medical device. Retrieval of a dislodged AmplifEYE follows the general principles of foreign-body removal under endoscopy. We believe that the endoscopic basket is a good tool but, because of its shape, resistance by the mucosa during removal is to be expected. We recommend using a balloon dilator that aligns and holds the balloon, the AmplifEYE and the scope together, and they can be removed smoothly as a unit. Conflict of interest statement: none declared. References 1 Biecker E Floer M Heinecke A et al.  . Novel endocuff-assisted colonoscopy significantly increases the polyp detection rate: a randomized controlled trial. J Clin Gastroenterol  2015; 49: 413– 18. Google Scholar CrossRef Search ADS PubMed  2 Kennedy RS Starker RA Feldman KA et al.  . Cost varies with procedure type in pediatric GI foreign bodies. J Pediatr Surg  2016 1 September [Epub ahead of print]. 3 Lake JP Essani R Petrone P et al.  . Management of retained colorectal foreign bodies: predictors of operative intervention. Dis Colon Rectum  2004; 47: 1694– 8. Google Scholar CrossRef Search ADS PubMed  © The Author(s) 2017. Published by Oxford University Press and Sixth Affiliated Hospital of Sun Yat-Sen University This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

Journal

Gastroenterology ReportOxford University Press

Published: Feb 17, 2017

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