THE NEW PRACTICAL EDUCATION FOR GASTROENTEROLOGISTS
Tips for a Difficult Colonoscopy
SPEAKER – Dr. Doug Rex, MD
Indiana University, Indianapolis, USA
Practical and Interactive Learning
This Expert Series session is designed to be interactive and provide simple tips for your practice to help you achieve high-quality colonoscopy and improve cecal insertion rates.
What will you learn?
Critical Problem Solving: Focus on classifying anatomical challenges, distinguishing between redundant colons and severely angulated sigmoid colons to tailor your approach effectively.
Game-Changing Techniques, such as:
Strategic Scope Selection: Understand when to use a standard scope (for redundant colons) versus skinnier options like pediatric, ultra-slim, or upper endoscopes.
Essential Water Immersion: Master the technique of "going in underwater" to shorten redundant colons, navigate difficult sigmoid colons, and crucially, prevent barotrauma perforations.
Optimized Steering & Pressure: Learn advanced techniques like the "left-hand scope grip" and effective, directional abdominal pressure for superior control and loop management.
Rethink Follow-up Strategies: Understand why radiographic studies (CT colonography, barium enema) are often insufficient for polyp detection in these complex patients, guiding decisions for repeat colonoscopy or referral.
Key Takeaways for Successfully Navigating Difficult Colonoscopies
Classify the problem: Determine if the challenge is a redundant colon or a difficult sigmoid.
Choose the right scope: Select the appropriate scope (standard for redundant, skinny/ultraslim for angulated sigmoid).
Go in underwater: Turn off gas at the source and utilize the water immersion technique from the start.
Use pressure effectively: Employ strategic abdominal pressure and the left-hand scope grip for optimal steering and loop management. Additionally, document precise maneuvers for future attempts, and consider an overtube for particularly challenging redundant colons.
