Post written by Mike T. Wei, MD, from Stanford University, Stanford, and Veterans Affairs Palo Alto, Palo Alto California.

We present a case of a 64-year-old man with history of C5 spinal cord injury who presented for screening colonoscopy. Unfortunately, due to significant looping, the colonoscope was only able to reach the transverse colon. The colonoscope was withdrawn and the Pathfinder rigidizing overtube (Neptune Medical, Burlingame, CA, USA) was used, and together the cecum was reached easily in 8 minutes.     

Our case illustrates the utility of the rigidizing overtube in assisting in difficult colonoscopies. The rigidizing overtube is 85-cm long and exists in 2 states, flexible or stiffened. Application of a vacuum allows for stiffening of the overtube up to 15 times. The rigidizing overtube can help with challenging colonoscopies by managing various types of loops. Although techniques such as single-balloon enteroscopy and double-balloon enteroscopy may be available as an alternative, these techniques are much more time intesive and are not performed by most gastroenterologists.      

The rigidizing overtube is a tool that we believe can be used by most gastroenterologists. The overtube can be especially helpful in difficult colonoscopies, in helping to manage loop formation. Further, the overtube can also stabilize the endoscope tip and facilitate maneuvers such as polypectomy.     

While further studies are needed to explore the utility of the rigidizing overtube, we feel one way in which the rigidizing overtube can help with daily practice is in the setting of challenging colonoscopies.    

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