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

Video Transcription

Video Summary

In this video, Amit Rastogi, a professor of medicine at Kansas University, discusses tips and techniques for navigating a difficult colon during a colonoscopy. He emphasizes the importance of good technique and efficient insertion to reach the C-curve with the least amount of scope insertion and colonic distension. He also stresses the willingness to quit when unable to reach the C-curve despite best efforts.<br /><br />Rastogi discusses the anatomical considerations of the colon, including mobile areas (sigmoid and transverse colon), areas that can be stretched and elongated (sigmoid, transverse, and flexures), and areas with sharp turns and twists (rectosigmoid, sigmoid, and flexures). He explains how these factors affect the behavior of the colon during colonoscopy. He also explains the two main problems encountered in difficult colons: sharp fixed angulation and redundant colon resulting in looping.<br /><br />Rastogi provides tips and techniques for negotiating these difficulties, such as using a pediatric colonoscope or gastroscope for sharp fixed angulation, holding the scope with fingers for better tactile perception, insufflating fluid instead of gas to reduce the angulation, torquing the scope rather than pushing, using pressure in specific directions, changing the patient's position, and changing to a smaller diameter scope if necessary.<br /><br />He also discusses the use of water immersion colonoscopy, scope guide technology, abdominal binders, rigidizing over tubes, and double balloon endoscopes as adjuncts or alternative methods for difficult colonoscopies. He emphasizes the importance of documenting the difficulty in the report for future reference and the option of referring the patient to an expert if needed.<br /><br />In conclusion, Rastogi highlights the need to anticipate and take necessary steps to navigate a difficult colon during colonoscopy, including using appropriate techniques and equipment, applying pressure strategically, and considering alternative methods or referring to an expert if necessary.

Asset Subtitle

Amit Rastogi, MD, FASGE

Keywords

colonoscopy tips

difficult colon navigation

colon anatomy considerations

problems in difficult colons

techniques for negotiating difficulties

alternative methods for difficult colonoscopies

importance of documenting difficulty