Practical Gastrointestinal Endoscopy

120
CHAPTER 6
Fig. 6.25–A single-handed
dexterity test: five full up/down
angulations can be done in 20
seconds.
and uncoordinated movements rapidly summate, prolonging
the procedure unnecessarily.
A table-top dexterity test will check efficiency of left-hand
angulation technique, or will at least demonstrate the problems.
Perform five full bending section retroflexions from maximally
up to maximally down (with no help from the right hand); this
can be done in around 20 seconds—but only fully and rapidly
(and single-handedly) if the ‘helper finger’ is brought into action
(Figs 6.17 and 6.25).
Insertion through the colon should be as quick as reasonably
possible because the pushing and looping of the insertion phase
is uncomfortable and stressful for the patient. Full inspection
should be on the return journey—although better views of some
areas are obtained on the way in when the colon is stretched; any
small polyps seen should therefore be destroyed during the insertion
phase, because they can easily be missed in the shortened
colon on the way back. However, trying to hurry colonoscope
insertion, using aggression and force to attempt speed, is usually
self-defeating and ends up in a slower, traumatic or failed
insertion. The sigmoid colon is an elastic tube (Fig. 6.26). Inflated
it becomes long and tortuous; deflated it is significantly shorter.
When stretched by a colonoscope, especially if overinflated as
well, the bowel forms loops and acute bends (Fig. 6.27) but if
shortened down and deflated it can be telescoped into a few
convoluted centimeters (Fig. 6.28) (rather like pushing a coat- or
shirt-sleeve up to expose the arm).
The following are simple general principles for comfortable
and safe insertion:
•–Suction air frequently and fluid infrequently. A perfect view isn’t
necessary during insertion. Whenever fully distended colon is
seen or if the patient feels discomfort it takes only a second or two
Fig. 6.26–The sigmoid colon is an
elastic tube …
Fig. 6.27–… pushing loops
it …
Fig. 6.28–… but pulling back
shortens and straightens the
colon.