Approaching a Difficult Colonoscopy - Scoping Summary Risk factors for failed C-scope: • Incr Age • Female sex • History of abdominal or pelvic surgery • Private practice setting Most common reason: 1) Redundant Colon 2) Difficult Sigmoid Variable stiffness scopes (VSC): • Higher cecal intubation rate • Fewer position changes • similar cecal intub. time, sedation time & manual pressure Water assisted colonoscopy: • Water exchange C-scope • Water immersion in failed/redundant colons • Incr cecal intubation rates • Decr the need for external straightening devices and position changes Prone positioning: • Obese patients -> shorter cecal intubation times 420s vs 550s Abdominal pressure: • Successful C-scopes - 78% L. sided pressure, 47% R. sided pressure Abdominal Binder: • Reduced Cecal intubation time • Less position changes, distension, pressure • Abdominal Compression Device (ACD) • ACD vs manual pressure -> reduction in cecal intubation time 6.38 min vs 11.8 min By Dr. Hassaan Zia @HassaanZiaMD via ScopingSundays @ScopingSundays #Incomplete #Difficult #Colonoscopy #Summary #Endoscopy #diagnosis #management #algorithm
