Wei MT, Friedland S. Strategies to manage the difficult colonoscopy. World J Gastrointest Endosc 2023; 15(7): 491-495 [PMID: 37547242 DOI: 10.4253/wjge.v15.i7.491]
Corresponding Author of This Article
Mike T Wei, MD, Clinical Assistant Professor, Department of Gastroenterology, Stanford University Medical Center, 300 Pasteur Drive, Palo Alto, CA 94306, United States. mtwei@stanford.edu
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Endosc. Jul 16, 2023; 15(7): 491-495 Published online Jul 16, 2023. doi: 10.4253/wjge.v15.i7.491
Strategies to manage the difficult colonoscopy
Mike T Wei, Shai Friedland
Mike T Wei, Shai Friedland, Department of Gastroenterology, Stanford University Medical Center, Palo Alto, CA 94306, United States
Author contributions: Wei MT wrote the paper, Friedland S provided editing for paper.
Conflict-of-interest statement: Shai Friedland: Consultant to Capsovision, Intuitive Mike T. Wei: Consultant to Neptune Medical, AgilTx, Capsovision.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Mike T Wei, MD, Clinical Assistant Professor, Department of Gastroenterology, Stanford University Medical Center, 300 Pasteur Drive, Palo Alto, CA 94306, United States. mtwei@stanford.edu
Received: February 26, 2023 Peer-review started: February 26, 2023 First decision: May 16, 2023 Revised: May 22, 2023 Accepted: June 19, 2023 Article in press: June 19, 2023 Published online: July 16, 2023
Abstract
During endoscopy, an endoscopist is inevitably faced with the occasional “difficult colonoscopy,” in which the endoscopist finds it challenging to advance the endoscope to the cecum. Beyond optimization of technique, with minimized looping, minimal insufflation, sufficient sedation, and abdominal splinting when needed, sometimes additional tools may be needed. In this review, we cover available techniques and technologies to help navigate the difficult colonoscopy, including the ultrathin colonoscope, rigidizing overtube, balloon-assisted colonoscopy and the abdominal compression device.
Core Tip: In all colonoscopies, we recommend optimizing technique, with minimal insufflation, sufficient sedation, minimal looping, water immersion, and having staff apply abdominal pressure when needed. When the cecum cannot be reached despite this, we consider utilization of additional tools, including overtube or specialized endoscope (e.g., ultrathin colonoscope).
