ASGE Masterclass: Expert Performance Approach to Colonoscopy (On-Demand)

Video Transcription

Video Summary

The session reviews best practices for navigating colonoscopy by keeping the colonoscope as straight as possible in an organ that is naturally curved and mobile. A straight scope improves both mucosal inspection and therapeutic stability. The speaker emphasizes recognizing loop formation, reducing loops promptly, and using a stepwise “algorithm” rather than repeatedly forcing the same approach. Equipment and technique should be tailored to anatomy: for fixed angulation or diverticular disease, a pediatric or even ultrathin scope (shorter bending radius), water-assisted insertion, and position changes (often supine) may help. For redundancy/looping common in obesity, an adult/stiffer scope, water, prone positioning, and selective use of the stiffener are prioritized. Common loops (alpha/end loops) are usually reduced with clockwise (right) torque plus adequate withdrawal; insufficient pullback often recreates the loop. Without imaging, tactile feedback and restoration of one-to-one tip movement guide loop reduction. Abdominal pressure should be applied precisely to prevent re-looping. Ergonomics and room setup also matter.

Keywords

colonoscopy navigation

loop recognition and reduction

scope straightening technique

water-assisted insertion

position changes and abdominal pressure