ASGE International Sampler (On-Demand) | 2024-The very difficult insertion

The very difficult insertion

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In this document, the author discusses the challenges faced during colonoscope insertion, specifically in cases of angulated sigmoid and redundant colon. The author provides recommendations and techniques to overcome these difficulties.<br /><br />For angulated sigmoid, the author suggests using a pediatric colonoscope or gastroscope, holding the scope with fingers like a pencil, and using water-aided techniques to keep the sigmoid straight. Torquing rather than pushing is recommended to negotiate turns.<br /><br />In cases of redundant colon, the author advises anticipating the problem by considering factors such as obesity and previous abdominal surgeries. Loop reduction is key, and techniques such as gas insufflation and water immersion are recommended to facilitate cecal intubation. The author also highlights the importance of specific hand pressure, abdominal massage, and being ready to quit or refer to a more experienced colleague if necessary.<br /><br />The document also mentions the use of an abdominal binder for lower abdominal compression, magnetic endoscopic imaging for better visualization, and rigidizing overtube to prevent loop formation. The author emphasizes the significance of evaluating hernias and, if present, reducing or applying pressure accordingly.<br /><br />In conclusion, the document emphasizes the need to anticipate difficult colonoscope insertions, document challenges in reports for future reference, and be prepared to refer to experts. It provides several techniques and adjunctive tools that can be used to facilitate successful cecal intubation in cases of angulated sigmoid and redundant colon.

Keywords

colonoscope insertion

angulated sigmoid

redundant colon

pediatric colonoscope

torquing technique

loop reduction

cecal intubation

abdominal binder

magnetic endoscopic imaging

rigidizing overtube