GASTROENTEROLOGY ARTICLE OF THE WEEK
January 22, 2009
Rex DK. Achieving cecal intubation in the very difficult colon. Gastrointest Endosc 2008;67:6
1. Maneuvers likely to help cecal intubation in a patient with a redundant colon include
a. changing to a thinner, less stiff instrument
b. Reducing all the loops to create a 1-to-1 transmission of shaft movement to tip motion
c. Avoid over-insufflation, use frequent suctioning to “advance” the instrument
d. Rotating the patient to the R lateral
decubitus position may help advance the endoscope from the ICV to the cecum
True or False
2. A variable stiffness
colonoscope significantly increases the rate of cecal intubation in patients
with difficult colons
3. Over ¾
of patients with incomplete colonoscopy due to “redundant colon”
require specialized equipment to complete the study
4. The best approach to traverse an angulated sigmoid is to increase the stiffness of the colonoscope
5. Assistant
applied abdominal pressure should be released prior to straightening the scope
6. Colonoscopy overtubes are particularly useful for angulated sigmoids
7. Targets for cecal intubations in the United States are 95% for screening colonoscopy and 90% for all colonoscopies
8. Sharp angulated sigmoids are more common in females, particularly thin females
9. Once the instrument is in the ascending colon, left lower quadrant pressure usually helps
10. If a tortuous colon cannot be intubated with pressure and position change, a colonoscopy overtube may help, particularly if the the looping is taking place in the transverse colon
Wondering what the “left hand shaft grip” is? –
Here
it is
