First Year Fellows Endoscopy Course (July 30-31)

6-Diagnostic_Colonscopy
Pdf Summary
The ASGE First Year Fellows Endoscopy Course covers the diagnostic colonoscopy procedure, including its indications, contraindications, technique, and trouble-shooting. <br /><br />Indications for colonoscopy include screening for average or high-risk individuals, surveillance for those with a history of pathology, and diagnostic purposes to investigate gastrointestinal symptoms, unexplained GI bleeding, iron deficiency anemia, inflammatory bowel disease, 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 colonoscopy technique involves starting with a careful perianal exam, followed by a digital rectal examination that includes a sweep of the anal canal and prostate examination in males. The 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 as much as needed (considering CO2 for insufflation), keeping the colonoscope lubricated, and paying attention to the patient's level of discomfort. <br /><br />The procedure involves identifying anatomic landmarks such as the rectum, sigmoid colon, splenic flexure, transverse colon, hepatic flexure, ascending colon, cecum, and terminal ileum. Techniques for successful terminal ileal intubation include deflating the scope, hooking the scope tip between the lips of the ileocecal valve, and using the bow & arrow sign. <br /><br />Loop formation and reduction are important aspects of colonoscopy, with predictable areas of loop formation in retroperitoneal and below peritoneal spaces. The most important technique for colonoscopy is non-specific abdominal pressure applied by an assistant at specific areas to prevent looping during intubation. <br /><br />Abdominal pressure is applied suprapubically, in the left lower quadrant, and in the left mid-abdomen depending on the scope location. If there is difficulty passing the hepatic flexure, rotating the patient halfway back to supine can often help. <br /><br />Scope withdrawal involves cleaning the colon, checking behind folds using retroflexion, and being meticulous in examining the mucosa. It is important to take time, be methodical, and note the quality of the prep and any other findings.
Keywords
ASGE First Year Fellows Endoscopy Course
diagnostic colonoscopy
indications
contraindications
technique
trouble-shooting
screening
surveillance
gastrointestinal symptoms
anatomic landmarks