A Newly Developed, Intraluminal, Safely-Sealed, Air Supply Unit-Detachable Balloon Unit to Rapidly Wash the Transcolorectal Route for NOTES

HAO XU, MD, Takeshi Ohdaira, MD, Norifumi Tsutsumi, MD, Megumu Mori, MD, Munenori Uemura, Ph D, Makoto Hashizume, MD. Department of Advanced Medicine and Innovative Technology, Kyushu University Hospital

Aim: In NOTES for the upper gastrointestinal tract, the colorectal route has a great advantage because the endoscope and the target organ are found on the same straight line. However, it is bacteriologically very difficult to wash the colorectal route. Much less has been the common belief that washing of the colorectal route in a short time immediately before surgery was impossible to conduct. We developed a balloon unit for NOTES capable of washing the colon in a short time and of safely separating the washed from unwashed portions for a long time.
Material and Methods: The silicon balloon is diamiter11X70 mm in outer size, and its minor axis extends to a maximum of diameter80 mm. The balloon has the following features: 1) Its tail has a sealing connector that allows the attachment and detachment of an air tube; 2) The tube for balloon deflation is retracted in the balloon itself; and 3) The balloon is radioluminescent, which allows the identification of its location. Furthermore, this exhaust thin tube packed in core of the balloon out of the body contributes to safety because it becomes a tube to tract the balloon out of the body when the balloon accidentally could not be drawn by endoscopic forceps. The air unit was originally developed as a high-speed air compression unit. We used 6 pigs of 38-40 kg in body weight. No laxative was used at all before conducting NOTES. Originally developed ozone nano-bubble water was used as the wash after balloon setting; 2,000mL of the water were used for washing.
Results: Time required from the anal insertion of the balloon to the onset of surgery was 9.0±3.5 min, and time between from deflation to balloon retrieval out of the body was 2.0±1.0 min. Washing level: According to the grade standard of the clinical bowel preparation for capsule endoscopy, the results of the endoscopic observation (per hour/6 hours, n = 2) were level I. Pressure/blocking level: Under the optimum pressure, observed the hindrance effect of sealing balloon (per hour/6 hour, n = 2), the result is that there is no intestine contents and the Gentian violet which is injected into the unwashed oral side intestine past through. Injury: The endoscopic observation of the sealing balloon’s expansion pressure point and the mucosa of the washed part (per hour/6 hours, n = 6) showed that there was no mucosal hyperemia, edema, blood branches in blurred or disappeared ,or bleed had been seen. Pathological findings: The sections of the intestines mucosa at the site of expansion (n = 3) revealed neither injury of the intestinal mucosa, nor the presence of invasive inflammatory cells.
Conclusion: This method may be a fast, safe washing method which can not only allow intestinal visualization and washed in paragraph effectively, but also keep the washing effect for a long time and reduce the risk of abdominal cavity infection potentially caused by transcolorectal NOTES.

Session: Emerging Technology Poster
Program Number: ETP011
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