First Year Fellows Endoscopy Course (July 29 - 30)

6-Diagnostic_Colonscopy

Pdf Summary

This document provides an overview of diagnostic colonoscopy, including indications, contraindications, technique, and troubleshooting. The indications for colonoscopy include screening for average-risk and high-risk individuals, surveillance for patients with a history of pathology, and diagnostic purposes for unexplained gastrointestinal symptoms, GI bleeding, iron deficiency anemia, inflammatory bowel disease, 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.<br /><br />The technique of colonoscopy involves starting with a careful perianal exam, including a digital rectal examination and prostate examination in males. Basic rules of colonoscopy include not advancing the colonoscope without a clear view of the lumen, pulling back when in doubt, not advancing if there is resistance, using as little air as possible and keeping the colonoscope lubricated, and paying attention to the patient's level of discomfort.<br /><br />Anatomic landmarks for colonoscopy include the rectum, sigmoid colon, descending colon, splenic flexure, transverse colon, hepatic flexure, ascending colon, cecum, and terminal ileum. Loop formation and reduction are important aspects of colonoscopy to prevent complications and improve visualization. Techniques such as non-specific abdominal pressure in specific areas can help in reducing loops and facilitating scope passage.<br /><br />During scope withdrawal, it is important to clean the colon, check behind folds using retroflexion, be meticulous, and note the quality of the bowel prep and any other findings. The document emphasizes the importance of being aware of body position and being comfortable during the procedure, as well as taking the time to be thorough and methodical.<br /><br />In summary, this document provides a concise overview of the indications, contraindications, technique, and troubleshooting for diagnostic colonoscopy, highlighting the importance of proper patient positioning, loop reduction, and thorough examination during scope withdrawal.

Keywords

diagnostic colonoscopy

indications

contraindications

technique

troubleshooting

screening

gastrointestinal symptoms

inflammatory bowel disease

anatomic landmarks

scope withdrawal