Initial design of a novel suction enteroscope for endoscopic locomotion in the small bowel (with video)

Background

The upper GI tract and the colon are readily accessible endoscopically, but the small intestine is relatively difficult to evaluate.

Objective

To demonstrate the feasibility of using suction as a means of locomotion and to assess the initial design of a suction enteroscope.

Design

Feasibility study.

Setting

Animal laboratory.

Intervention

Various prototype suction devices designed in our laboratory were tested in swine small intestine in a force test station. For in vivo experiments in live anesthetized animals, two suction devices (1 fixed tip and 1 movable tip) were attached to the outside of the endoscope. By creating suction in the fixed tip, the endoscope was anchored while the movable tip was advanced. Suction was then applied to the extended tip to attach it to the distal bowel. Suction on the fixed tip was then released and the movable tip with suction pulled back, resulting in advancement of the endoscope. These steps were sequentially repeated. Intestinal segments were sent for pathologic assessment after testing.

Results

Force generated ranged from 0.278 to 4.74 N with 64.3 to 88 kPa vacuum pressure. A linear relationship was seen between the pull force and vacuum pressures and tip surface area. During in vivo experiments, the endoscope was advanced in 25-cm segmental increments with sequential suction-and-release maneuvers. No significant bowel trauma was seen on pathology and necropsy.

Limitation

The enteroscopy system requires further refinement.

Conclusion

A novel suction enteroscope was designed and tested. Suction tip characteristics played a critical role impacting the functionality of this enteroscopy system.

Abbreviations:  ABS, acrylonitrile butadiene styrene, MSD, modified suturing device