Quick Tips on Colonoscopy Techniques

Preface to the English Edition
One would expect demand for colonoscopy to be as high outside Japan as it is in Japan. Insertion techniques feature prominently at live demonstrations and always attract a lot of interest from doctors outside Japan. Similarly, when hands-on training courses are offered at international society meetings, there is no shortage of eager applicants. So it would seem that many young doctors outside Japan are just as interested in being able to quickly master colonoscopy insertion techniques as those in Japan. Yet, oddly enough, few texts on the subject of Japanese colonoscopy insertion techniques have been published in English, which begs the question: how exactly do young doctors overseas learn colonoscopy insertion techniques? Considering this problem, we thought it would be a good idea to put out an English edition of this book. What distinguishes this book from others on the subject is that the various elements particular to colonoscopy insertion are broken down into a set of detailed topics, which are then discussed by a variety of experts, each of whom offers tips on the same theme − keeping it as simple as possible. For the reader, this offers important benefits. First of all, it makes clear that there are multiple opinions on how best to achieve a given goal and different methods for doing so. This gives the reader the opportunity to learn and develop techniques that suit their own style and preferences. Secondly, because this book starts out with basic explanations, it contains a lot of material that will be enormously helpful to colonoscopists who are just beginning their training, as well as those who have already gained a moderate level of experience. As co-editors-in-chief, it is with great pleasure and the utmost confidence that we recommend this English edition to colonoscopists all over the world.
1. Amount of Air during Scope Insertion  
1.How to feed the right amount of gas during scope insertion
2.Controlling the amount of air during insertion using the technique “by shortening the colonic fold through bending"
3.Three misconceptions about insufflated air
4.Amount of air - four associated points
5.ays to reduce the amount of air in the intestinal tract
6.Controlling the amount of air is critical during scope insertion
2. Changing the Patient's Position and Applying Hand Pressure  
1.Changing the patient's position and applying hand pressure during scope insertion
2.Patient positioning and hand pressure : Two very effective and frequently used techniques
3.Essential techniques - Patient positioning and hand pressure
4.Tips on patient position change and hand pressure
5.Roles of patient position change and hand pressure in overcoming difficulties and pains
6.Effectiveness of patient position change and hand pressure
7.Basic hand pressure points
3. Using a Sliding Tube  
1.Advantages, disadvantages and precautions when using a sliding tube
2.Indications for sliding tube
3.When is the sliding tube applicable ?
4.Tips on use of the sliding tube
5.Effective use of the sliding tube
4. Insertion into the Rectum  
1. Select a scope appropriate to the patient
2. Help the patient relax and get the information you need to perform insertion
3. Things that should be done before insertion
4. Start with a rectal examination
5. "Catching the bend"
6. Insertion into the anus, passage through the anal canal and rectum, and observation of these regions
5. Passing the Rs-S Junction  
1.Passing the rectosigmoid junction using knowledge of the location's contours based on three-dimensional anatomy
2.Hooking-the-fold technique and rotation factor
3.Effective use of patient position changes and external abdominal pressure
4.Getting past the Rs-S junction is the key to a successful colonoscopy
5.Passing through the Rs-S junction the right way is the key to success
6.Tips on passage through the Rs-S junction
7.The trick is to reduce the amount of air in the rectum
6. Passing the SD Junction 
1.The two basic SD junction passage techniques that need to be mastered
2.Take the configuration of the sigmoid colon into consideration
3.There are two ways to pass SD: the push method and the pull method
4.Shortening and stretching techniques for the sigmoid colon
5.Methods for passing through the sigmoid colon
6.The SD junction is the best and most important part for the “straightening and shortening method" of insertion
7. Passing the Splenic Flexure 
1. How to deal with problems at the splenic flexure
2. Splenic flexure bending toward the left
3. Tips for smooth passage of the splenic flexure
4. How to achieve smooth insertion into splenic flexure
5. Importance of straightening the scope and making the splenic flexure less acute
6. What you need to know about splenic flexure passage
8. Advancing in the Transverse Colon 
1. After passing through splenic flexure - what next ?
2. Suction and intestinal tract shortening are also essential in the transverse colon
3. Basic maneuvers and applied techniques
4. Key points in passage of transverse colon
5. Tips for advancing the scope in the transverse colon
6. The importance of shortening the colon and resolving any loops
9. Passing the Hepatic Flexure 
1.Remember, "haste makes waste"
2.Hepatic flexure bending toward the right
3.Hook the flexure with the scope's distal end
4.Taking advantage of the descending phenomenon of the hepatic flexure, together with hand compression on the abdomen and patient position change
5.Using respiratory assistance, patient position change and hand pressure
6.Key tips on passing through the hepatic flexure
10. From the Cecum to the Terminal Ileum 
1.Indication for terminal ileum insertion and insertion frequency
2.Conditions required for scope insertion into terminal ileum
3.Scope insertion from the cecum to the ileum
4.Appendix orifice, the terminal point of colonoscopy
5.Important tips in the path from cecum to terminal ileum
6.Getting from the cecum to the terminal ileum by preserving the scope's freedom of movement
11. How to Deal with Cases Where Insertion Is Difficult 
1) Postoperative Adhesion
  • 1.Never use force to manipulate the scope
  • 2.Carefully pass each fold, using as little air as possible
  • 3.Always assume that an adhesion may be present before insertion
  • 4.Areas where insertion is difficult vary depending on whether and where the patient has undergone surgery
  • 5.Tips for insertion in postoperative adhesion cases
  • 6.Take a surgical history in the pre-procedure interview
2) Dolichocolon (Sigmoid Colon, Transverse Colon)
  • 1.Dolichocolon and air insufflation
  • 2.Measures to be taken before and after sigmoid colon insertion
  • 3.How to handle the case of dolichocolon (long colon)
  • 4.Countermeasures against dolichosigmoid
  • 5.Ways to deal with dolichocolon cases
3) Other
  • 1.Advanced obesity cases
  • 2.Patients undergoing pelvic radiation, patients with multiple sigmoid diverticula, thin women, elderly patients and patients with bloody stools
  • 3.Dealing with adhesions, patients whose position cannot be changed, transversecending colon loops, sigmoid colon volvulus and melena
12. Examining Elderly Patients (80 or Older) 
1.Caution is required for insertion in elderly patients
2.Watch out for any changes in vital signs
3.The importance of avoiding risks and knowing when to stop
4.Elderly patients usually have more fragile colons
5.Key points when examining patients aged 80 or older
13. Preventing Perforation during Insertion 
1.Do not use force to manipulate the scope
2.Always perform insertion carefully and be prepared to discontinue the procedure before completion
3.The importance of identifying high-risk cases
4.Avoid applying excessive force to the colon wall
5.Situations where perforation can occur and how to avoid them
6.When caution is required during insertion
14. Observation Tips
1.When is the best time for observation ?
2.Observation by withdrawing the scope a little at a time
3.Always pay attention to superficial elevated type and depressed type lesions
4.How to avoid missing lesions in blind spots
5.Tips on detection and diagnosis
6.Tips on accurate qualitative diagnosis using standard colonoscopic observation
7.Important points to keep in mind during observation
15. Retroflexed Observation in the Rectum
1.Rectal observation is a must
2.Observation without dead angles
3.The purpose of retroflexed observation and some points to remember
4.Do not take easy observation of the rectum
5.Eliminating blind spots in rectal observation by retroflexing the scope
16. Dye Spraying 
1. Dye spraying, safety of dyes
2.Reasons for dye spraying and how to do it
3.Contrasting technique
4.Contrast method and staining method
5.Tips on dye spraying and observation
6.How to wash lesions and spray dyes