ASGE Endo Hangout: Colonoscopy/Tools of the Trade

Video Transcription

Video Summary

The ASGE Endo Hangout webinar titled "Colonoscopy, Tools of the Trade" features expert gastroenterologists discussing practical approaches and best practices in colonoscopy, focusing on scope selection, polyp removal, and procedural techniques. Dr. Raj Kiswani, Dr. Jasmine Sinha, and GI fellow Kathy Wang facilitate an interactive session addressing common clinical scenarios.<br /><br />Key topics include the choice between pediatric and adult colonoscopes. While pediatric scopes offer greater flexibility and patient comfort, adult scopes provide a larger working channel and may reduce loop formation. The panel highlights reviewing prior colonoscopy reports to guide scope selection, with emphasis on anatomical considerations and sedation history. Switching scopes during challenging navigation is encouraged to improve patient comfort and procedural success.<br /><br />Withdrawal techniques are discussed, emphasizing adequate inspection time (8-20 minutes depending on experience), AI assistance, and the use of mucosal exposure devices like caps, Endocuff, and balloon tips to enhance polyp detection. For polyp management, cold snare polypectomy is advocated for lesions under 1 cm due to its safety and effectiveness, with jumbo forceps as an alternative for very small polyps. Larger or flat polyps may require advanced techniques including EMR—cold, conventional, or underwater—depending on size, morphology, and location.<br /><br />Tattooing is recommended for marking malignant or suspicious lesions away from anatomical landmarks, with saline blab technique preferred to avoid deep tissue spread. Biopsy sampling should focus on targeted areas rather than number of bites.<br /><br />The panel stresses procedural preparation, availability of tools including snares, lifts, clips, and hemostatic agents, and the importance of mastering technique and scope handling to optimize outcomes. Overall, the session reinforces evidence-based, patient-centered decision-making in colonoscopy to enhance quality and safety.

Keywords

Colonoscopy

Scope selection

Polyp removal

Withdrawal techniques

Pediatric colonoscopes

Adult colonoscopes

Cold snare polypectomy

Endoscopic mucosal resection (EMR)

Tattooing lesions

Biopsy sampling

Procedural preparation