ASGE Masterclass: Colonoscopy (Virtual Only) | January 2022-Questions, Answers and Discussion: Part 2

Video Transcription

Video Summary

In the video, the speaker discusses the value and features of the terminal ileum and how to differentiate it from more worrisome patterns during intubation. They explain that the terminal ileum has a villi pattern that transitions to a normal colonic pattern, which is characterized by round circles uniformly distributed on the surface. The speaker emphasizes the importance of training the eye to recognize these patterns and suggests using posters and routine colonoscopy practice to reinforce this awareness. The next topic discussed is the sizing of polyps and the challenge of inter-observer variability. The speaker recommends comparing the size of the polyp to the instruments used during the procedure, such as the sheath of the snare or the open snare. They also mention that the management for polyps between 2 and 9 millimeters is the same, so slight differences in size measurement may not be clinically significant. The speaker then discusses the JNEC classification and its value in identifying irregular patterns that may indicate superficially invasive cancer. They explain that this information can help guide the appropriate resection technique for the lesion. The speaker suggests resources such as ASGE teaching tools and recommends writing detailed reports and comparing them to the pathology results to improve confidence and accuracy in assessment. They also address challenges related to poor colon prep and recommend aggressive washing and suctioning to improve visualization with narrow band imaging (NBI) . The speaker highlights the importance of technique in adenoma detection rate (ADR) and recommends focusing on withdrawal technique, spending at least 6 minutes in each segment, distributing the time across the colon, and using tools like the clock on the screen to track time. The speaker also suggests considering more than 6 minutes as an aspirational goal for withdrawal time.

Asset Subtitle

Moderator Aasma Shaukat, MD, MPH, FASGE

Keywords

terminal ileum

intubation

polyp sizing

JNEC classification

colon prep

adenoma detection rate