Ahead of #ScopingSundays "Basics of Colonoscopy" session on 26th July 2020;

I tweet My guide to Colonoscopy for trainees.

My qualification
- BCSP colonoscopist
- Endoscopy training lead
- Completed TCT course
- Faculty on Basic skills in Colonoscopy courses

1/

My guide to Colonoscopy - left colon

- Once into the sigmoid, get pt into supine position
- If views still restricted, get pt into Rt lateral position
- A loop will likely form in the sigmoid, N - then 𝝰 loop
- Keep going to TC, or not making progress, or pt in pain

2/

My guide to Colonoscopy - reducing sigmoid loop

- If 𝝰 loop, lots of clockwise torque & pull back
- If N loop, clockwise torque & pull back
- Reduce loop carefully, aim to keep luminal view
- Once scope is straight, stiffen scope
- Push scope slowly with clockwise torque

3/

My guide to Colonoscopy - transverse colon

- Once in TC with straight scope, lie pt supine
- Keep going to HF, or not making progress, or pt in pain
- To straighten scope, pull back with anti-clockwise torque
- Push, if scope kinks in TC or sigmoid, try abdo pressure

4/

My guide to Colonoscopy - right colon

- Once tip of scope in right colon, reduce scope carefully
- Trying to get a '? shape' on the scope guide
- Easier to reach caecum with straight scope
- Better views in supine position
- Pulsed suction & slowly push forward

5/

My guide to Colonoscopy - caecal manoeuvres

- If stuck at ICV, reduce scope, abdo pressure, push
- If mobile SF, ask pt to hold breath for 5 secs & push
- Inspect caecum slowly, wash if needed
- If debris / stool in caecum, position change to clear
- Photograph AO & ICV

6/

My guide to Colonoscopy - if TI inspection needed

- Try to get scope above ICV
- Once ICV below tip of scope, advance past ICV
- Un-stiffen scope
- Look down, pull back slowly
- Tip of scope should catch lips of ICV
- Once into ICV, insufflate, slowly advance to view TI

7/

My guide to Colonoscopy - withdrawal / inspection

- Slow withdrawal, steady, clear fluid pools
- Supine for caecal views, supine / left lat for Rt colon
- Supine for TC views, carefully inspect HF / SF
- Supine / Rt lat for left colon views
- Left lat for rectal retroflexion

8/

My guide to Colonoscopy - tips 1

- Read Cotton/Williams book & watch video for theory
- Bed at correct height
- Umbilicus on inside of Lt wrist, relaxed grip
- Roll scope between fingers to torque
- Don't worry if you fall back
- Position change supine to Rt lat often helps

9/

My guide to Colonoscopy - tips 2

- If scope kinks despite abdo pressure consider prone
- 100% CIR isn't possible
- Use appropriate sedation, if pt in a lot of pain abandon
- Practice is the key

Check out #ScopingSundays session on 26th July 2020 for tips from experts

10 & end/