Initial experience of a through-the-scope balloon device for ileal intubation in Crohn's disease

      Intubation of the terminal ileum (TI) is necessary to assist in the diagnosis of suspected Crohn's disease (CD) and is the preferred method to assess disease activity or postoperative recurrence in patients with known CD. However, a number of factors may limit successful ileal intubation, including anatomic difficulties of the native disease, acute angles of anastomoses, and fibrostenosis. Additionally, ileal CD may spare the most distal TI, so deeper intubation is required to assess this effectively. Other modalities of assessment have been limited by their inability to biopsy (capsule endoscopy or radiologic imaging) or the requirement of special equipment (deep enteroscopy with current single- or double-balloon devices). The Navi-Aid (Smart Medical Systems, Ra'anana, Israel) (Fig. 1) is a through-the-colonoscope balloon device with a single pressure-sensitive, automated insufflation balloon that enables the endoscopist and assistant to “pull” the colonoscope deeper into the ileum (Fig. 2) while the balloon anchors it further inside. Navi-Aid is a U.S. Food and Drug Administration-approved endoscope accessory that ensures positioning of a standard endoscope in the small intestine.
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      Figure 1The Navi-Aid device through the channel of a colonoscope (balloon inflated).
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      Figure 2Deployment of the Navi-Aid in a patient with known Crohn's disease. A, The device is embedded in the ileum proximally. B, After automated balloon insufflation, the colonoscope is pushed by endoscopist while the assistant “pulls” the small bowel toward the tip of the colonoscope.
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