ASGE Masterclass: Colonoscopy (Virtual Only) | January 2022-4_Rastogi_Negotiating the difficult

4_Rastogi_Negotiating the difficult_defiant colon

Pdf Summary

This document provides tips and tricks for negotiating a difficult or defiant colon during a colonoscopy. The author discusses various techniques for efficient cecal intubation, minimizing complications, and dealing with anatomical challenges. Some of the key points include:<br /><br />- Efficient cecal intubation can be achieved by using good technique, inserting the scope straight, and minimizing colonic distension.<br />- Anatomical considerations such as sharp angulations, redundant colon loops, and mobile segments of the colon should be taken into account when planning the procedure.<br />- For sharp/fixed angulations, using a pediatric colonoscope or gastroscope, holding the scope like a pencil, and torquing the scope can help navigate the turns.<br />- Reducing redundant loops can be done by using alpha or reverse alpha techniques, water immersion, and applying pressure in specific directions.<br />- The document also discusses techniques for negotiating other challenging segments of the colon, such as the splenic flexure, transverse colon, hepatic flexure, and ascending colon.<br />- Additional strategies mentioned include water-assisted colonoscopy, the use of abdominal binders, magnetic endoscopic imaging, and rigidizing overtube.<br />- Finally, the document advises documenting the difficulty in the report for future reference and being willing to quit and refer to an expert if necessary.<br /><br />Overall, this document provides helpful insights for gastroenterologists and other healthcare professionals performing colonoscopies in cases of a difficult or defiant colon.

Keywords

colonoscopy

cecal intubation

anatomical challenges

techniques

colonic distension

angulations

redundant colon loops

water-assisted colonoscopy

abdominal binders

expert referral