Looping and Abdominal Pressure: A Visual Guide to a Successful Colonoscopy.

Looping is a common occurrence during colonoscopy. Once a loop has occurred and the endoscopist has reduced it, abdominal pressure given by the technician will help the loop from re-forming. In this article, we discuss some of the common loops that are formed, the methods the endoscopist must employ to reduce the loop, and the type of abdominal pressure used by the technician to help prevent the loop from re-forming and, thus, help attain cecal intubation. Hand placement for abdominal pressure is discussed and illustrated to provide a visual guide for the technician.

Use of an electromagnetic colonoscope to assess maneuvers associated with cecal intubation.

BACKGROUND: Safe and effective colonoscopy is aided by the use of endoscopic techniques and maneuvers (ETM) during the examination including patient repositioning, stiffening of the endoscope and abdominal pressure. AIM: To better understand the use and value of ETM during colonoscopy by using a device that allows real-time imaging of the colonoscope insertion shaft. METHODS: The use of ETM during colonoscopy and their success was recorded. Experienced colonoscopists and endoscopy assistants used a commercially available electromagnetic (EM) transmitter and a special adult variable stiffness instrument with 12 embedded sensors to examine 46 patients. In 5 of these a special EM probe passed through the instrument channel of a standard pediatric variable stiffness colonoscope was used instead of the EM colonoscope. RESULTS: Thirty-nine men and 7 women with a mean age of 64 years (range 33-90) were studied. The cecum was intubated in 93.5% (43/46). The mean time to reach the cecum was 10.6 minutes (range 3-25). ETM were used a total of 174 times in 41 of the patients to assist with cecal intubation. When ETM were required to reach the cecum, and the cecum was intubated, an average of 3.82 ETM/patient was used. While ETM were used most often when the tip of the colonoscope was in the left side of the colon (rectum 5.0%, sigmoid colon 20.7%, descending colon 5.0%, and splenic flexure 11.6%), when the instrument was in the transverse colon (14.8%), hepatic flexure (20.7%) and ascending colon (19.8%) the use of ETM was also required. When the colonoscope tip was in the transverse colon, hepatic flexure and ascending colon, ETM success rates were less (61.1%, 52.0%, and 41.7% respectively) compared to the left colon success rates (rectum 83.3%, sigmoid colon 84.0%, descending colon 100%, and splenic flexure 85.7%). CONCLUSION: The EM colonoscope allows imaging of the insertion shaft without fluoroscopy and is a useful device for evaluating the efficacy of ETM. ETM are important tools of the colonoscopist and are used most often in the left colon where they are most effective.

Safe and effective abdominal pressure during colonoscopy: forearm versus open hand technique.

Safe and effective colonoscopies may depend on several factors. The technique of the physician, effectiveness of the preparation, and the patient's previous surgeries are key factors in providing a complete colonoscopy. However, a very important aspect of providing a safe and effective colonoscopy for the patient is not only the physician's expertise, but also abdominal pressure techniques that can be provided by the assistant. These techniques, which have not been widely publicized until the last few years, will assist in anus-to-cecum surveillance of the colon. It is important to recognize that proper technique is vital to prevent injury to both the patient and the assistant providing the pressure. In this article, three techniques are discussed; however, only two are recommended. One technique (open hand) is noted as a technique that may have the potential to cause injury to the assistant. Effective and safe abdominal pressure will aid in the comfort of the patient and may shorten the time it takes to complete the procedure.

The importance of abdominal pressure during colonoscopy: techniques to assist the physician and to minimize injury to the patient and assistant.

This article outlines techniques that can be used to assist the physician's ability during colonoscopy to achieve cecal intubation in both standard situations and in specific conditions such as the obese patient. When applied properly, abdominal pressure can help shorten the length of the procedure, minimize the angle of turns in the colon, and minimize discomfort to the patient. A Mayo physician survey unanimously concluded that abdominal pressure is beneficial during colonoscopy. This article addresses the ergonomics of applying pressure and suggests techniques that minimize risk of injury to both the patient and the assistant. In addition, questions that new assistants may ask are addressed.