First Year Fellows Endoscopy Course (July 28-29)

6-Diagnostic_Colonscopy
Pdf Summary
The ASGE First Year Fellows Endoscopy Course covers the topic of diagnostic colonoscopy with a focus on indications, contraindications, technique, and troubleshooting. <br /><br />Indications for colonoscopy include screening for both average and high-risk individuals, surveillance for those with a history of pathology, and diagnosis of unexplained GI symptoms, GI bleeding, iron deficiency anemia, IBD, and abnormal imaging of the colon. <br /><br />Contraindications for colonoscopy include perforated intestine, acute diverticulitis, deep ulcerations, severe ischemic necrosis, fulminant colitis, cardiopulmonary decompensation, and inability to tolerate bowel prep. <br /><br />The technique of colonoscopy starts with a careful perianal exam and a digital rectal examination. Basic rules of colonoscopy include not advancing the colonoscope without a clear view of the lumen, pulling back when in doubt, and not advancing with resistance. Other rules include using as little air as possible and as much as needed, keeping the colonoscope lubricated, and paying attention to the patient's discomfort level. <br /><br />Anatomic landmarks during colonoscopy include the rectum, sigmoid colon, descending colon, splenic flexure, transverse colon, hepatic flexure, ascending colon, cecum, and terminal ileum. Tips for successful terminal ileal intubation include deflating, hooking the scope tip between lips of the ileocecal valve, and using the bow and arrow sign. <br /><br />Loop formation and loop reduction techniques are also discussed. The most important technique for colonoscopy is non-specific abdominal pressure, which involves an assistant pushing at predetermined areas to prevent looping during intubation. <br /><br />Endoscope withdrawal involves cleaning the colon, checking behind folds using retroflexion, and being meticulous in assessing the mucosa. Summary points include reviewing indications and risks/benefits, being comfortable and aware of body position, using water immersion, position changes, and abdominal pressure during insertion, reducing loops, and taking time and being methodical during scope withdrawal.
Keywords
diagnostic colonoscopy
indications
contraindications
technique
troubleshooting
screening
GI bleeding
IBD
anatomic landmarks
scope withdrawal