ASGE Masterclass: Colonoscopy (On-Demand) | January 2022-Tips and Tricks to Negotiate the Difficult/Defiant Colon

Video Transcription

Video Summary

In this video, Professor Amit Rastogi, a professor of medicine at Kansas University, discusses tips and techniques for navigating a difficult colon during colonoscopy. He highlights the importance of good technique, minimal scope insertion, and avoiding complications such as loops and resistance. He emphasizes the willingness to quit when unable to reach the C-curve despite best efforts. Anatomical considerations and factors that impact colon behavior during colonoscopy are also discussed, such as body habitus, scarring from prior surgeries, and history of radiation therapy. Professor Rastogi then goes on to address the two main problems encountered when navigating a difficult colon: sharp fixed turns or angulations and redundant colon causing loops. He provides recommendations and strategies to tackle these issues, including using a pediatric colonoscope or gastroscope, holding the scope with fingers for better tactile perception, insufflating fluid instead of gas, torquing the scope instead of pushing, and applying pressure in different regions of the abdomen. Other techniques such as water immersion, abdominal binders, scope guide, and overtubes are also highlighted as adjunctive measures. Professor Rastogi concludes by reminding viewers not to push against fixed resistance without a visible lumen and to document the difficulty and measures taken in the report. He emphasizes the importance of recognizing the need to quit and referring to an expert if necessary.

Asset Subtitle

Amit Rastogi, MD, FASGE

Keywords

colonoscopy

difficult colon

techniques

complications

anatomical considerations

navigating

colon behavior