![]() If the stricture is very tight and does not allow passage of a standard colonoscope, the endoscopist should downsize to a pediatric colonoscope or a gastroscope, although the latter instrument can only be used if the stricture is in the left colon. JW When dealing with a tight stricture, the endoscopist should be very careful. G&H How should endoscopists handle tight colonic strictures (benign or malignant) that resist standard colonoscope passage? ![]() When using this very flexible and, thus, floppy instrument, it is often helpful to also use a wire stiffener (such as a steel guidewire) to keep the colonoscope straight so that the endoscopist can intubate the entire colon. However, an extremely slender colonoscope has recently been developed by several instrument manufacturers that is ideal for patients in whom it is difficult to get around the sigmoid colon because the tip of this new instrument bends very acutely and acts more like a gastroscope than a colonoscope (except for being very long). In general, I prefer to use a pediatric colonoscope for my primary instrument. ![]() ![]() When used in a difficult sigmoid colon, the rigidity of the segment can act as a stent for the gastroscope, allowing it to be placed through the entire colon and reach the cecum.įor navigating around the hepatic flexure in tall men or obese patients, I recommend using a heavier colonoscope, such as a standard adult colonoscope with variable stiffness, which will keep the instrument straighten Once the more rigid colonoscope goes through the bends and folds of the sigmoid colon and splenic flexure, the cecum is almost always reached. However, a gastroscope cannot be used to perform an entire colonoscopy in the average patient because this instrument is shorter than a colonoscope, and its length is taken up by the bends and folds of the sigmoid colon. If intubation through the sigmoid colon is still not possible, I recommend using a gastroscope, which, due to its short radius of curvature (ie, very short nose), can easily negotiate the acute, tight bends of the sigmoid colon. A pediatric colonoscope is a little smaller in caliber and has a shorter nose (deflecting tip) and tighter radius of curvature compared with a standard colonoscope. JW For patients in whom it is difficult to get through the sigmoid colon (eg, women who are young and slender, patients who have undergone pelvic surgery, or those with severe diverticular disease), it may be worthwhile for the endoscopist to use a pediatric colonoscope instead of a standard colonoscope. G&H Can specialized colonoscopes help endoscopists negotiate colons in difficult circumstances? In these patients, the colonoscope can get lost in the long colon and the very tall or large splenic and hepatic flexures, making it difficult to reach the end of the colon. The second place where difficulty can arise during colonoscopy is the hepatic flexure, particularly in tall men or obese patients. This problem is found in young, slender women as well as patients who have had pelvic surgery, such as a hysterectomy or another gynecologic surgery. One is the sigmoid colon, where it can be difficult to get around the acute bends of the rectosigmoid and the sigmoid descending colon junction. Therefore, young, slender women comprise the most difficult category of patients for colonoscopy.ĭuring colonoscopy, there are 2 places where difficulty can occur. The younger the person, the more pain may be experienced during colonoscopy due to tight mesenteries over time, mesenteries become more elastic and, thus, more lax. In addition, age may predict the difficulty of a colonoscopy. Women are more likely to have a difficult colonoscopy because it has been shown that they have longer colons than men packed into a smaller abdominal cavity, resulting in many twists and turns in the colon. One such factor is the presence of surgical adhesions. JW A difficult colonoscopy (ie, a colonoscopy in which the endoscopist has trouble getting through the entire colon or fails to do so) may be caused by several factors. G&H What factors are predictive of a difficult colonoscopy?
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