Colonoscopy Techniques and Procedures

A colonoscope includes a control section, instrument channel, shaft, tip, connection section, and connection line.

Colonoscope tip movement is controlled by two knobs: a larger outer knob for vertical (up/down) movement and a smaller inner knob for lateral (left/right) movement.

Specific areas of the large intestine (rectum, sigmoid, splenic/hepatic flexures) are often challenging to visualize during a colonoscopy.

Before the procedure, the patient is positioned left lateral (on their side), knees pulled up. Perianal region is examined and a digital rectal exam with topical anesthetic is performed.

The digital rectal exam (DRE) prelubricates the anal canal and relaxes sphincters, aiding in the colonoscopy procedure.

The anal canal is a short segment, approximately 2-3 centimeters long, extending from the anal verge to the dentate line.

During colonoscopy, when the scope is positioned opposite the colon mucosa, the view becomes completely red, known as the red-out sign.

To overcome the red-out sign, air is inflated into the anus using an air/water infusion valve button.

The rectum measures approximately 15 centimeters in length, starting from the dentate line and extending to the rectosigmoid junction (RSJ).

The rectum is fixed to the retroperitoneal wall, making it relatively immobile and easy to advance the colonoscope through.

Three folds in the rectal wall, known as Houston's valves, are located in a left-right-left pattern.

The rectosigmoid junction (RSJ) is the first difficult area during colonoscopy intubation, typically with the lumen opening towards the left.

When a loop forms at the RSJ during colonoscopy, the scope must be pulled back to remove it. Apply left torque and mild pushing to advance.

ERCP stands for Endoscopic Retrograde Cholangiopancreatography. It's a medical procedure that uses a flexible endoscope to visualize and treat problems in the bile ducts and pancreatic duct.

ERCP can be used for diagnosis and treatment. It's useful for identifying blockages, narrowing, or other issues in the bile and pancreatic ducts. It can also treat those conditions.

ERCP is often done when problems in the bile or pancreatic ducts are suspected. These problems can be caused by tumors, gallstones, inflammation, infections, or other conditions.

Before ERCP, patients must have an empty upper GI tract (no food, drink, smoking, or chewing gum for 8 hours). Medications might need adjustment or cessation. Dentures, jewelry, and contact lenses must be removed.

ERCP usually requires deep sedation. This ensures stable positioning for the endoscope and allows for safe and effective procedures.

The sphincter of Oddi is a muscular valve at the opening of the common bile duct and the pancreatic duct in the duodenum. It controls the flow of bile and pancreatic juices.

During ERCP, a flexible endoscope is inserted through the mouth and travels through the digestive tract until it reaches the duodenum. From there, the bile duct and pancreatic duct can be accessed through the ampulla of Vater.

ERCP can be used therapeutically to perform several procedures including sphincterotomy, stone removal, stent placement, balloon dilation, and tissue sampling.

Endoscopic retrograde cholangiopancreatography (ERCP) is a procedure that uses a flexible endoscope to examine the bile ducts and pancreatic duct. This technique involves inserting an endoscope through the mouth and into the duodenum, then using X-ray imaging to visualize the bile and pancreatic ducts.

ERCP is used to diagnose and treat conditions of the biliary tract, gallbladder, and pancreas. It can be used to remove gallstones stuck in the bile ducts, place stents to improve drainage, or biopsy suspicious areas.

A thin, flexible tube inserted through the nose and into the bile duct during ERCP to help drain bile. This helps to ease pressure and improve drainage from the biliary system.

A type of cancer that originates in the cells of the bile ducts, either inside or outside the liver.

A technique where a second, smaller scope is inserted through the channel of the first endoscope to provide a closer look at the bile and pancreatic ducts.

Duodenoscope-assisted cholangiopancreatoscopy, a technique using a smaller scope through the main ERCP scope to break up gallstones or provide detailed views.

While generally safe, ERCP can have complications including bleeding, infection, pancreatitis, or perforation of the duct. The risk is higher in patients with complex medical conditions.

The success rate of ERCP can vary depending on the experience of the physician and the complexity of the case. It's generally high (70-95%), but complications can occur in 1-5% of cases.

Possible complications of ERCP include infection, pancreatitis, allergic reaction to sedatives, excessive bleeding, puncture of the GI tract or ducts, tissue damage from radiation exposure, and in rare cases, death.

ERCP is generally contraindicated for patients with unstable cardiopulmonary, neurologic, or cardiovascular status, existing bowel perforation, or altered surgical anatomy. It's also relatively contraindicated in patients with coagulation disorders.

Endoscopy is a minimally invasive medical procedure that uses a flexible tube with a camera to examine the interior surface of an organ.

Endoscopes are flexible tubes equipped with lenses, a light source, and are often paired with a microchip camera to display images on a monitor. Light is provided by optical fibers.

A type of endoscopy used to examine the upper digestive tract, including the esophagus, stomach, and duodenum.

A type of endoscopy that examines the small intestine, a part of the digestive tract that's usually difficult to visualize due to its length and structure.

A type of endoscopy used to examine the large intestine, including the colon and rectum.

A specialized type of endoscopy that uses X-rays and imaging dye to look at the bile ducts and pancreatic duct.

Endoscopy is generally considered superior to radiology, except for evaluating problems with muscle movement in the digestive tract.

Endoscopy can be used to take tissue samples (biopsies), understand pain causes like inflammation or ulcers, and even find cancer.

Endoscopy can treat bleeding by injecting medicine or using clips, remove foreign objects, widen narrow areas, insert tubes for feeding or supporting the gut, and place stents.

Gastric ulcers, ulcers in the stomach, are often found in the first part of the duodenum, which is the first part of the small intestine right after the stomach.

Reaching deeper into the small bowel can be tricky. It's long, narrow, and has a lot of twists and turns.

This is a type of small bowel endoscopy where the doctor gently pushes the scope forward, relying on the natural movement of the intestines.

This type of small bowel endoscopy uses a special scope with two balloons, one to hold the scope in place and another to pull it back slowly, increasing the viewing area.

This method uses a tiny camera in a capsule that the patient swallows. The camera takes pictures as it travels through the digestive tract.