| Theme | How to facilitate insertion on difficult colonoscopy | |
|---|---|---|
| Title | Overcoming difficulties during total colonoscopies | |
| Publish Date | 2005/05 | |
| Author | Yutaka Saito | Division of Endoscopy, National Cancer Center Hospital |
| Author | Takahisa Matsuda | Division of Endoscopy, National Cancer Center Hospital |
| [ Summary ] | In our experience, 6 % of patients needed sedation for total colonoscopy. Total colonoscopy could not be achieved in 0.5 % of patients due to adhesions in the colon or excessively long colons. For such cases, a technique maintaining the axis, with the shortening method is essential. Moreover, it is important to keep in mind the following basic techniques : (1) hold the scope gently a distance of 40 cm from the anal verge to feel the resistance free state with the scope, (2) handle the scope slowly and do not use an excessive jiggling technique, (3) avoid excessive suction in the air since this may cause collapse of the lumen, which is not effective. (4) until reaching the S-D junction, use only the rotation of the scope, mainly, and try not to push the scope. (5) for rotation of the scope, do not use the right-left angle, and use rotation of the scope with the right hand. For difficult cases, we sometimes push the scope slowly, rotating it to the left and shortening the scope after passing through the SD junction. In the transverse colon, we use not only the hooking the fold technique but also the slalom technique. Furthermore, abdominal compression and posture changing techniques are useful to perform a total colonoscopies in difficult cases. |
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