Practical Gastrointestinal Endoscopy

134
CHAPTER 6
?
?
(a)
No
Yes
(b)
Fig. 6.50–(a) Choosing the correct path can be difficult in diverticular
disease … (b)… a circular view is a diverticulum—the lumen will be at
90° and is often squashed.
proximal colon in a patient in left lateral position) and also holding
the mucosal folds away from the lens to improve the view.
Be prepared to abandon if postoperative or peridiverticular adhesions
have fixed the pelvic colon so as to make passage impossible
or dangerous. If there is difficulty, if the instrument tip feels
fixed and cannot be moved by angling or twisting and the patient
complains of pain during attempts at insertion, there is a danger
of perforation and the attempt should be abandoned. Sometimes
a different endoscope (e.g. pediatric colonoscope or gastroscope)
or another endoscopist may succeed. Only a very experienced
colonoscopist with very good clinical reasons should put the patient
and instrument at risk under these circumstances; usually
the most experienced are the most prepared to stop and refer for
another form of imaging.
Sigmoid–descending junction
The sigmoid–descending junction is probably the trickiest