The Evidence
for Pathfinder^®

Endoscopic submucosal dissection (ESD) in the colon is a technically challenging procedure. Poor scope maneuverability and loop formation are one of the primary reasons for failure of colonic ESD. The novel Rigidizing Overtube (RO) (Pathfinder; Neptune Medical, USA) has been reported to be useful to prevent loop formation during colonoscopy. Once the overtube has been advanced to the desired location, application of a vacuum stiffens the overtube which allows the endoscope to advance through the overtube without loop formation in the region where the overtube has traversed.

A 42 year-old patient with a history of iatrogenic bile duct transection during cholecystectomy underwent HJ; HJ stricture required balloon-assisted enteroscopy with ERCP to place a stent. The stent was removed after three months but restricturing occurred leading to left-sided intrahepatic stone disease. As a result, multiple antegrade double balloon enteroscopies were required to treat accessible intrahepatic stones, but several remained and could not be accessed due to difficult angulation and looping. Pathfinder was used to advance to the HJ without looping in the stomach and provided improved control up the ascending PB limb. A stone extraction balloon was then able to remove the bilary duct stones; imaging confirmed stone remove and bile duct clearance. The clinical team suggested that the device may be useful in other altered anatomy ERCP cases when anterograde approaches fail and a luminal approach is required.

In the case of an 85 year-old patient with a large ascending colon polyp (7cm x 4cm), the site was difficult to reach with conventional colonoscopy methods due to looping of the patient’s long colon. Pathfinder greatly assisted with stability during piecemeal underwater EMR of the lesion. The clinical team reported that the stability the overtube provided, combined with its adaptive flexibility, allowed for easy insertion and secure positioning for a complex endoscopic procedure.