Masterclass Colonoscopy: Trends and Recommendations Forward (On-demand) | February 2024-The Very Difficult Insertion: The angulated sigmoid, the redundant colon

Video Transcription

Video Summary

Dr. Amit advises on techniques to handle difficult colonoscopies, specifically focusing on angulated sigmoid and redundant colons. He stresses the importance of good colonoscope insertion techniques, including using the straightest possible scope, avoiding excessive colon distension, and minimizing loops. Dr. Amit explains that the colon has anatomical variabilities, and its behavior during insertion is influenced by factors such as body habitus, scarring from prior surgeries, and presence of hernias. He advises taking a good history and examining the abdomen before starting the procedure to anticipate any difficulties. Dr. Amit offers tips and maneuvers to navigate angulated sigmoid and redundant colons, emphasizing the use of water immersion instead of gas insufflation, torque and turn the scope rather than push, apply appropriate abdominal pressure, and change positions if needed. He also recommends using a smaller caliber scope, such as a pediatric colonoscope or gastroscope, when dealing with an angulated sigmoid. If necessary, he advises changing to a pediatric colonoscope or gastroscopy for a tightly turned colon. Dr. Amit emphasizes the importance of documenting difficulties in the procedure report and being prepared to refer the patient to a more experienced colleague if needed. He also discusses additional techniques and tools that may help navigate difficult colonoscopies, such as the use of abdominal binders, scope guides, or magnetic endoscopic imaging. Overall, Dr. Amit emphasizes the importance of anticipating and preparing for difficult insertions and taking appropriate measures to successfully reach the CECM while minimizing complications.

Asset Subtitle

Amit Rastogi, MD, FASGE

Keywords

colonoscopy techniques

angulated sigmoid colon

redundant colon

colonoscope insertion

abdominal examination

water immersion

pediatric colonoscope