VideoGIE| Volume 84, ISSUE 3, P534-535, September 2016

Endoscopic overtube-guided deployment of a video capsule endoscope

Published:March 25, 2016DOI:
      A 58-year-old woman with polycystic kidney disease had recently undergone renal transplantation complicated by recurrent small-bowel obstruction with perforation and primary surgical anastomoses. Subsequently, she experienced melena, for which anterograde single-balloon enteroscopy (A-SBE) (Olympus SIF-Q180/ST SB-1 Overtube, Olympus, Center Valley, Pa, USA) and introduction of a video capsule endoscope (VCE) (Given Pillcam SB3, Given Imaging, Yokneam Israel) were performed. After the A-SBE was completed past the first anastomosis, the overtube was left in place at the point of maximal insertion with the balloon inflated, and the endoscope was withdrawn. The VCE was placed into the overtube and propelled forward with the endoscope, thus being deployed directly into the jejunum beyond the anastomosis (Fig. 1A; Video 1, available at Both the capsule width and the inner diameter of the SB-1 overtube are 11 mm (Fig. 1B), although the double-balloon overtubes are smaller (Fujinon TS-12140 [10.0 mm]/13140 [10.8 mm] [Fujinon, Wayne, NJ, USA]). The first VCE image was in the jejunum, distal to the anastomosis. Traditional evaluation of obscure small-bowel bleeding in the setting of altered anatomy is limited by sequential approaches, antecedent endoscopic trauma confusing VCE interpretation, incomplete VCE transit resulting from poor motility, and an inability to intuit anastomoses on VCE interpretation alone. In conclusion, endoscopic overtube-guided deployment of a VCE overcomes several of these obstacles to enable efficient identification of the source of overt, occult bleeding.
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      Figure 1A, Method of introducing the video capsule endoscope (VCE) into the overtube. After completion of the single-balloon–assisted enteroscopy, the overtube (Olympus ST SB-1) is left in position with the balloon inflated, and the enteroscope (Olympus SIF-180) is withdrawn. The capsule is introduced into the overtube, and the enteroscope is reintroduced behind the capsule to propel it out of the overtube into the jejunum. B, The Given Pillcam SB3 is 11 mm wide and 26 mm long. The ST SB-1 overtube has an inner diameter of 11 mm, which accommodates the capsule; however, available Fujinon double-balloon overtubes have inner diameters that are less than 11 mm.
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