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Colonoscopy difficulties & solutions.
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Colonoscopy: How to increase its role in diagnosing/ prevention of
CRC.
Solutions & advances.Solutions & advances.
Colonoscopy:Colonoscopy:
Objectives of colonoscopy.Objectives of colonoscopy.
Difficulty of colonoscopy.Difficulty of colonoscopy.
Summary.Summary.
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Introduction
• The main objectives of colonoscopy is early detection of CRC & their precursors adenomas.
• CRC is the second leading cause of Ca−related deaths.
• Adenomas( occur in25% males/ 15% females > 50 ys are the benign precursors of CRC& their removal results in a lower than expected incidence of CRC.
• Detection of CRC at an early stage improves the prognosis.
Colonoscopy is more difficult:Colonoscopy is more difficult:
Time
Less completion
More Complex
/risky prep
30 mins vs 5 mins.
75% vs nearly 100%.
Involving use of strong cathartics.
>Time Consuming30 vs 5 mins
Less completion75 vs 100%
More Complex/risky
preparation.
Difficult colonoscopy: struggling to reach the cecum.Colonoscopy is more difficult than OGD:
Difficult colonoscopy: causesDifficult colonoscopy: causes
Colooscopist factors
Patient
factors
Both
Canadian J of GE: August 2007.
Experience
Timing
Training
Practice volume:
Factors
Morning vs evening,Early vs late work hours.
Manual dexterity.
Better with high volume practices.
Colonoscopist factors:Colonoscopist factors:
Female SEX:SEX:
More long, tortuous angulated colon.
No ideal BMI:No ideal BMI:
Too fat or too thin.Too fat or too thin.
Diverticular diseasePrevious operation with adhesions.
Patient factors:
Patient factors:Patient factors:
Colonoscopist & patient factors:Colonoscopist & patient factors:
Preparation:Need good patient-doctor cooperation.
Loops & Angulations:
Too much air insufulations.
Less patient cooperation.
Loops are the enemies of colonoscopy.
Sedation failure:
Doctor or patient factors.
Tricks: New techs: New equips:
1.Appropriate insufflations.
2.Appropriate deflation.
3.Delooping when occur.
4.Deep breathing in major bends.
5. Changing positions.
6.Withdrawal time( > 6 mins) recording.
7.Adenoma detection rate recording( 25% males/ 15% females > 50 years).
1.NBI:2.Floresence
clonoscopy.3.TER.
Solutions for successful colonoscopy:Solutions for successful colonoscopy:
1.Snake-like articulated computer-controlled segments.
2.self-navigating, self-propelling device
3. DBC.4.WVCE.5. Over tube use.
Endoscopy 2008.
Solutions for successful colonoscopy:Solutions for successful colonoscopy:
Dr.Mohammad Shaikhani.
Assistant professor.
Sulaimani Univerity.
College of Medicine.
Iraqi Kurdistan.
