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ADDED COLON INSUFFLATION FROM A LAPAROSCOPIC INSUFFLATOR (LI) VIA A TRANSANAL PLATFORM DURING COLONOSCOPY DOES NOT INCREASE THE PEAK LUMINAL PRESSURES OBSERVED; ALSO, ADDED LI INSUFFLATION PREVENTS COLON COLLAPSE DURING SUSTAINED SCOPE SUCTION EVENTS.
Neil Mitra
*1, Elizabeth Nilsson Sjolander
1,2, Yi-Ru Chen
1, Jorge Castro-Otero
1, Malk Beydoun
1, Hmc Shantha Kumara
1, Richard L. Whelan
11Lenox Hill Hospital, New York, NY; 2North Shore University Hospital, Manhasset, NY
Introduction: During EMR or ESD sustained suction may be needed to remove pooled luminal fluid/debris; these suction events collapse the bowel leading to loss of the working field. Re-insufflation of the bowel and scope repositioning takes time. To maintain the working field during EMR/ESD some MD’s add a laparoscopic insufflator (LI) that is attached to a transanal platform through which the scope has been passed. Does added insufflation increase the overall pressures and risk of injury? Conversely, what LI flow rates and maximal pressures are needed to prevent collapse? Whereas pressure limits on LI’s are easily set and are known, the insufflation pressures (IP) generated by endoscopy towers are preset by the manufacturer, not adjustable and are unknown. This ex vivo porcine large bowel study measured the maximal IP’s generated by: 1) colonoscope, 2) an LI, and 3) the 2 sources together. A variety of LI maximal pressures (MP) and flow rates (FR) were assessed and the settings determined that would preserve colonic distension despite continued suction.
Methods: Ex vivo porcine large bowel specimens with anus were utilized plus a pediatric colonoscope/tower. A 4 cm transanal platform was inserted into the anorectum and the device’s gel cap (through which the colonoscope had been passed) attached to the outer end of the anal sleeve. The cap has ports with stopcocks that the LI can be attached to. Multiple MP’s and FR were assessed. Luminal pressures were measured with a digital measuring device attached to the scope handle working channel port or to the anal platform port. Four repetitions were done for each set of settings. Collapse times were determined for all settings assessed.
Results: A total of 91 measurements were made. The MP generated by the colonoscope was between 14-48 mmHg (mean 24.9 mmHg). The LI was employed only after the colon has been insufflated via the scope. The highest pressures observed with continuous LI for the following insufflation pressures and flow rates were: MP 4 mmHg with FRs of 8, 10, and 20 L/min, 5.4 to 5.9 mm Hg; MP 6 mmHg with FRs of 8, 10, and 20 L/min, 8.2 to 9 mmHg. When the two insufflators were run simultaneously the maximal pressure was 4.91-11.33 mmHg for 27 trials with set pressures of 4 and 6. Despite 2 minutes of continuous suction via the scope with LI settings of MP 4 mmHg and FR of 10 L/min or higher the colon did not collapse. With LI settings of MP 4 mmHg and FR of 8 L/min partial collapse was noted at 75-90 seconds.
Conclusion: Adding LI as a second colonic insufflation source does not increase the MP’s generated in the colon because the colonoscope’s peak insufflation pressures (manufacturer set) are notably higher than those associated with the LI. Also, supplemental LI can safely preserve the endoscopic field (no collapse or delayed collapse) despite maximal suction.
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