The use of transnasal endoscopy (TNE) is
growing at a rapid pace in the field of otolaryngology as an investigative and
interventional method for patients presenting complaints with the head and the
neck. Realizing the potential for transnasal endoscopy, Cook Medical recently
introduced Hercules
100 Transnasal Esophageal Balloon, a first-of-its-kind medical
device designed specifically for the transnasal oesophageal procedures. With a
much shorter balloon size than what is available in the market, Hercules 100 is
tailored to the scope that ENT physicians commonly use and the patient anatomy
they treat. The new tool allows patients to be treated on the same day they are
evaluated rather than waiting for weeks or months to get scheduled for the
procedure, saving the overall patient’s and physician’s time, and enhancing the
quality of treatment.
Hercules 100 Transnasal Esophageal
Balloon is a modification of Cook Medical’s existing Hercules 3 Stage Balloon,
which has been created for gastrointestinal use. Because the Hercules 100
balloon needs to be inserted trans nasally, the Cook engineers created the
oesophageal tool 140 cm shorter than its GI counterpart.
The transnasal esophagoscopy can be performed without administering general
anesthesia as it is a minimally invasive procedure and can be done in an office
setting, which leads to shorter recovery time and lower out-of-pocket costs to
the patients and the healthcare system. The Hercules 100 balloon comes in
different diameters to accommodate varying patient requirements.
Key Features and
Benefits of Hercules 100 Transnasal Esophageal Balloon
P.E.T. Flex™
technology
The oesophageal balloon is made with
proprietary P.E.T. Flex™ technology, a material with good barrier and clarity
properties made for optimal combination of high tensile strength, hardness,
durability, accuracy, and flexibility. The one-of-its-kind technology generates
a greater radial force on the oesophageal stricture at the same or lower
pressures when compared with other stageable balloon dilators.
Express Evacuation
Catheter
When negative pressure is applied to
the catheter with an inflation device, the Express Evacuation Catheter deflates
the balloon and even if the clinicians initiate the withdrawal process before
deflation, Hercules can be still withdrawn into the endoscope. The
patient-pending Rapid Deflation Sleeve makes Hercules fast and efficient.
Kink-resistant
Nitinol Catheter
Nitinol catheter supports minimally
invasive interventional endoscopic procedures due to its superelasticity (10
times more elasticity than stainless steel) and thermal shape memory. The
nitinol catheter can handle serious bending without kinking or permanent deformation
and operate smoothly while bending around the tortuous paths.
Flexible Atraumatic
Tip
The flexible atraumatic tip allows
smooth accessibility through tight strictures and is configured to guide the
elongated shaft through the body lumen without any perforation.
Through-the-balloon
Visualization
The ultra-thin translucent balloons
permit excellent visualization of the stricture during the dilation progress.
The distal chip charge-coupled device technology enables rapid visualization of
the esophagus in the office setting without risking the morbidity and mortality
associated with anesthesia.
Hercules 100 Transnasal Esophageal
Balloon facilitates the conjunction of transnasal endoscopy with
balloon dilation, that present physician an opportunity to dilate all areas
of the esophagus through the nasal cavity and perform therapeutic procedures
like placing gastroenteric feeding tubes, oesophageal botulinum toxin
injection, and tracheoesophageal Puncture. The balloon dilators are being utilized
for decades in sedated endoscopy but due to its limitation, the new and novel
transnasal technique has gained more recognition by offering several
advantages. Transnasal balloon dilation can be performed either under local or
general anesthesia, at the preference of the patient however the dilation
technique is the same regardless of the anesthesia indication. Transnasal
endoscopy alleviates 50% of the complications by eliminating
the administration of general anesthesia, and thus decreases health risks for
patients. Transitioning the approach from transoral to transnasal via Hercules
100, the gag reflex becomes less prominent or even absent in some cases, which
enhances the tolerability of the patients for the procedure.
Another advantage of transnasal
balloon endoscopy with Hercules 100 is that patients with anatomic limitations,
which prevents treatment using rigid endoscopy under general anesthesia such as
severe trismus or limited neck extension due to previous oncologic therapy,
among other complications have a viable alternative. Utilizing Hercules 100
under topical anesthesia, the physicians can receive direct feedback from
the patient and aid them in reducing post-procedural pain.
In addition to being an ideal
screening tool, Hercules 100 can also be utilized for biopsies of the
esophagus, as well as other interventions such as reflux, dysphagia, and
difficulty swallowing, arising from different pathologies. The thin,
distal-chip, video esophagoscopes have transformed patients' care and allow the
clinicians to perform a comprehensive evaluation for proper diagnosis and
treatment.
Hercules 100 transnasal balloon
dilators are designed to offer enhanced procedural benefits compared to bougie
dilators. While balloon dilators provide controlled radial dilation and can be
used with a transnasal endoscope to provide visualization during the procedure,
bougies are not compatible with transnasal endoscopes and enable blind passage
of dilators for oesophageal perforation.
How is Hercules 100
balloon endoscopy performed?
- The patient is given topical anesthesia to
numb the nostrils and the procedure takes about 15 minutes.
- From the nostril, an endoscope tube with a
tiny light and camera at the end is inserted slowly into your esophagus.
The fluoroscopy imaging method is used to create a moving X-ray image of
the esophagus on the screen.
- Hercules 100 balloon dilator is carefully
guided into the scope working channel and positioned in the middle of the
stricture.
- Incremental dilation is performed through an
inflation device to fill the air with a balloon and widen the tight
strictures by relaxing the muscle fibers.
- The inflated balloon is then pulled against
the tip of the endoscope to allow the mucosal lining of the muscle to be
visualized.
Conclusion
Compared to transoral endoscopy,
patients are showing high affinity towards the transnasal balloon endoscopy,
owing to its advantages such as fewer complications, relatively less costs,
etc. Although the duration of TNE can take longer, the total time of transnasal
procedure is shorter than transoral procedure when pre-treatment and post-treatment
monitoring events are taken into consideration. Transnasal esophagoscopy with
Hercules 100 is safer and viable alternative to both unsedated and sedated
conventional transoral endoscopy.
According to TechSci
research report on “Global Endoscopy
Capsule Market By Product Type (Small Bowel, Esophageal, Colon) By
Accessories (Wireless Capsule v/s Workstation and Receiver) By Endoscope Type
(Capsule Cystoscopies v/s Capsule Neuro-Endoscopes) By Application (OGIB
(Obscure Gastrointestinal Bleeding), Crohn’s Disease, Small Intestine Tumor,
Others) By End User (Hospitals & Clinics, Ambulatory Care Center, Others)
By Company, By Region, Competition Forecast & Opportunities, 2026”, the global endoscopy
capsule market is expected to grow at a significant rate during 2022-2026. The
growth can be attributed to the rising incidences of gastrointestinal problems
and colorectal cancer, and the increasing demand for quick and accurate
diagnostics. Besides, government initiatives and patient’s preference for
choosing non-invasive methods are anticipated to boost the growth of global
endoscopy capsule market.
According to another TechSci report on “Global Intragastric
Balloons Market By Administration (Pill Form v/s Endoscopy), By Balloon
Type (Single, Dual, Triple), By Filling Type (Saline Filled v/s Gas Filled), By
Application (Obesity, Diabetes, Diet Control, Others), By End User (Hospitals
& Clinics, Ambulatory Surgical Centers, Others), By Region, Competition
Forecast & Opportunities, 2026”, the
global intragastric balloon market is anticipated to grow at a significant CAGR
during the forecast period due to increasing number of patients suffering from
obesity and rising government initiatives for research and development in the
domain.