ASGE Masterclass: Expert Performance Approach to Colonoscopy (On-Demand) | February 2026-Perforation: What do I do medically? What do I do legally?

Video Transcription

Video Summary

The speaker addresses strategies for traversing a very difficult, tightly angulated sigmoid colon (often due to severe diverticular disease). If a pediatric colonoscope cannot pass, they recommend trying an ultra-thin “super-slim” colonoscope (e.g., Olympus PCF-PH). If that still fails because a tighter turning radius is needed, a push enteroscope may work due to its shorter bending section and adequate length to reach the cecum. As a last resort, they describe an older guidewire-exchange technique: advance an upper endoscope as far as possible, place a long stiff “colon-length” guidewire (e.g., Savary), withdraw the upper scope, then use a snare through a pediatric colonoscope to backfeed the wire through the scope and advance over the wire to straighten the sigmoid.<br /><br />They then review colonoscopy perforation types, prevention, and medico-legal pitfalls (e.g., hot forceps for diminutive polyps). Barotrauma perforation is emphasized as rare but severe, especially in complex sigmoids with poor prep; prevention involves switching to water immersion and minimizing insufflation. Management includes prompt recognition, clip closure of injuries (Sydney classification), and urgent needle decompression for abdominal compartment syndrome without waiting for imaging.

Asset Subtitle

Doug Rex

Keywords

difficult sigmoid colon intubation

severe diverticular disease colonoscopy

super-slim ultrathin colonoscope (Olympus PCF-PH)

push enteroscope for colonoscopy

guidewire exchange technique (Savary wire)

colonoscopy perforation types and prevention

barotrauma perforation and water immersion

endoscopic clip closure (Sydney classification) and needle decompression