Colonoscopists vary in skill, technique & attitude in relation to the examination. These differences may have an impact on the quality of the examination and complications. The differences include methods used during colonoscope insertion and withdrawal, the type & dosage of medication, pain experienced and the incidence of hypotension and hypoxia. Studies show that Usage of ancillary techniques for colonoscope insertion reduces pain, opioids usage, & hypoxia/hypotension.
A colonoscope can be inserted in two ways. The less technical way is to push the colonoscope in without serious attempts to shorten the colon or straighten loops. This results in a relatively quick examination that can be completed for a majority of patients and is easy to learn. But it causes significant pain for the patient due to stretching of the colonic mesentery. It makes therapeutic manoeuvres dangerous as loops mean that the colonoscope is not under proper control.
The more technical and skilled method to intubate the colon is to shorten it by removing loops as the colonoscope is inserted, thereby minimizing mesenteric stretch and maximizing patient comfort. Therapeutic manoeuvres with a straight scope are easier and safer than when loops are present.
However the basic techniques of colonoscope insertion have been not discussed significantly except in textbooks, courses, and videos. Various types of sedation can be administered for colonoscopy: light sedation or deep sedation, any sedation or no sedation & conscious sedation or general anaesthesia. Moderate to deep conscious sedation involves lengthy recovery and can cause adverse cardiorespiratory events.
The ancillary techniques of colonoscope insertion helps in avoidance of loops and also promotes a smooth & comfortable colonoscopic examination. Reports show better outcomes and higher-quality examinations associated with ancillary techniques.
Various factors involved in colonoscopy are:
- Quality of bowel preparation
- Depth of insertion
- Time required for insertion
- Time required for withdrawal
- Procedures performed
- Shortest colonoscope inserted at the cecum
Some of the colonoscopy techniques are abdominal pressure (directed or not directed), turning the patient from supine to left position, from supine to right position, to prone position; asking the patient to hold his or her breath; using warm water flush to relax the colon; and using air flush to dislodge particles stuck on the suction channel. Another technique is the use of the variable stiffening dial on the colonoscope may well prevent recurrence of loops after they have initially been shortened.
Colonoscopy is an uncomfortable & fearful procedure for many patients. Conscious sedation is a commonly given in colonoscopy. Though the dosage of analgesics and sedatives given vary a lot among the surgeons. High dosage of analgesia and sedation are associated with hypoxia and hypotension.
Heavy sedation increases the hospital stay period. Ancillary techniques is associated with less pain, lower doses of sedation and analgesia, and lesser complications. Polyp detection is easier in a comfortable patient with a shortened colon than for a distressed or unconscious patient with a distended, looping colon. Polyp detection is easier with a straight scope because repeated inspections of a difficult area are more possible when the scope is straight.
Lasting hypoxia may need oxygen therapy. The way the scope is inserted makes a big difference in the level of comfort experienced by the patient, and therefore in the amount of sedation given and in the risks run. It also influences the degree of trauma experienced by the colon. Finally, therapeutic and diagnostic procedures are easier and safer with a cooperative patient and a straight colon.
In addition to promoting patient comfort and easy insertion, turning the patient is useful in moving pools of stool, opening various parts of the colon, and bringing polyps to a favourable position for removal.
The aim of colonoscopy is to achieve a thorough examination of the colon in the safest, most comfortable manner. Performance of colonoscopy requires patience, experience, and talent. Each patient has different needs, and every colon is a unique challenge. Development of skill performing colonoscopy takes time, and inherent in this lengthy learning curve is the adoption of ancillary techniques to ease insertion and make withdrawal more efficient. As skill increases, the need for sedation and analgesia decreases until the ideal of a comfortable exam in awake and relaxed patients is the norm.
For more information:
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