First Year Fellows Endoscopy Course (August 5 - 6)

6-Diagnostic_Colonscopy

Pdf Summary

This document provides an overview of diagnostic colonoscopy, including its indications, contraindications, technique, and troubleshooting. The indications for colonoscopy include screening for average and high-risk individuals, surveillance for individuals with a history of pathology, and diagnostic purposes for unexplained GI symptoms, GI bleeding, iron deficiency anemia, IBD, and abnormal imaging of the colon. Contraindications for colonoscopy include perforated intestine, acute diverticulitis, deep ulcerations, severe ischemic necrosis, fulminant colitis, cardiopulmonary decompensation, and inability to tolerate bowel prep. The technique of colonoscopy involves starting with a careful perianal exam, performing a digital rectal examination, and achieving anal intubation. Basic rules for colonoscopy include having a clear view of the lumen before advancing the colonoscope, pulling back when in doubt, not advancing if there is resistance, using as little air as possible, keeping the colonoscope lubricated, and paying attention to the patient's level of discomfort. Anatomic landmarks in the colon include the rectum, sigmoid colon, splenic flexure, transverse colon, hepatic flexure, ascending colon, cecum, and terminal ileum. Tips for successful terminal ileal intubation include deflating the bowel, hooking the scope tip between the lips of the ileocecal valve, and using the bow and arrow sign. Loop formation and loop reduction techniques are also discussed. The document emphasizes the importance of basic colonoscopy techniques, such as non-specific abdominal pressure, to prevent looping and facilitate scope passage. It also highlights the significance of thorough scope withdrawal, including cleaning the colon, checking behind folds with retroflexion, and taking the time to be meticulous and methodical.

Keywords

diagnostic colonoscopy

indications

contraindications

technique

troubleshooting

screening

surveillance

unexplained GI symptoms

GI bleeding

iron deficiency anemia