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



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