ASGE Masterclass: Colonoscopy (On-Demand) | January 2022-4_Rastogi_Negotiating the difficult

4_Rastogi_Negotiating the difficult_defiant colon

Pdf Summary

In this document, Dr. Amit Rastogi provides tips and tricks for negotiating a difficult or defiant colon during colonoscopy procedures. The document includes considerations for colonoscope insertion, anatomical considerations of the colon, and strategies for dealing with sharp/fixed angulation and a redundant colon.<br /><br />To negotiate sharp/fixed angulation, the author recommends taking a thorough patient history, reviewing previous colonoscopy reports, and using a pediatric colonoscope or gastroscope for known angulation. Techniques such as using water immersion, torquing the scope, and keeping the scope short are also suggested.<br /><br />For a redundant colon, the author advises anticipating and identifying signs of looping, reducing the loop, and providing specific directions to technicians regarding location and direction of pressure. Different techniques are recommended based on the location of the loop, such as clockwise torque for sigmoid loops and counterclockwise torque for splenic flexure loops.<br /><br />The document also discusses the use of water-assisted colonoscopy techniques, such as water immersion and water exchange, which have been shown to improve cecal intubation rates compared to gas insufflation. Other adjuncts, such as abdominal binders, magnetic endoscopic imaging scope guides, and rigidizing overtubes, are also mentioned as potential tools to aid in difficult colon navigation.<br /><br />The author emphasizes the importance of documenting the difficulty in the colonoscopy report for future reference and being prepared to refer the patient to a more experienced colleague or regional expert if necessary.<br /><br />Overall, this document provides a comprehensive overview of strategies for negotiating a difficult or defiant colon during colonoscopy procedures. By following these tips and tricks, clinicians can improve the success rates of colonoscopy and provide better patient outcomes.

Keywords

negotiating a difficult colon

defiant colonoscopy procedures

colonoscope insertion

anatomical considerations

sharp/fixed angulation

redundant colon

water immersion techniques

torquing the scope

looping in colonoscopy

water-assisted colonoscopy