A systematic review of the clinical effectiveness of a novel rigidizing overtube in completing difficult colonoscopies and for challenging colorectal polyp resection.

Background and Aims: Completing colonoscopy in redundant colons and resecting complex precancerous lesions are 2 challenging areas in the technical performance of colonoscopy. In this study, we conducted a systematic review to assess the clinical success of a rigidizing overtube (ROT) to facilitate completion of difficult colonoscopy insertions and challenging polyp resections. Methods: We used multiple electronic databases from August 2019 through June 2024 to identify studies evaluating the use of the novel ROT for colonoscopies. Results: Five studies were included with a total of 163 patients. Three studies evaluated the ROT system in challenging colonoscopies, with a combined cecal intubation rate of 100%. There were no adverse events. Four studies evaluated ROT for challenging colorectal polyp resection. The overall clinical success was 94.7%. Procedure facilitation was reported in 3 studies, with an average of 92.5% facilitation. One study compared endoscopic submucosal dissection (ESD) with and without ROT and reported similar en-bloc resection and curative rates with the use of ROT (92% and 88%, respectively) compared with conventional ESD (96% and 92%, respectively). In other studies that evaluated ROT in the removal of challenging polyps (60 patients), technical success was achieved in all cases. Conclusions: ROT is safe, shows potential in enhancing the clinical success of completing difficult colonoscopies, and may be useful for facilitating ESD and endoscopic mucosal resection of some colonic lesions. The mechanism of any benefit is likely in reducing looping in the case of previous incomplete colonoscopies and providing stability in the case of the complex resections. Further controlled studies are warranted and needed to confirm benefit.