minimally invasive diagnostic medical procedure used to assess the interior surfaces of an organ by inserting a tube into the body. The instrument may have a rigid or flexible tube and not only provide an image for visual inspection and photography, but also enable taking biopsies and retrieval of foreign objects. Endoscopy is the vehicle for minimally invasive surgery.

minimally invasive endoscopic examination of the large colon and the distal part of the small bowel with a CCD camera or a fiber optic camera on a flexible tube passed through the anus. It may provide a visual diagnosis (e.g. ulceration, polyps) and grants the opportunity for biopsy

or removal of suspected lesions. Virtual colonoscopy, Furthermore, virtual colonoscopy does not allow for

therapeutic maneuvers such as polyp/tumor removal or biopsy nor visualization of lesions smaller than 5

millimeters.

If a growth or polyp is detected using CT colonography, a standard colonoscopy would still need to be

performed. Colonoscopy can remove polyps smaller than one millimeter. Once polyps are removed, they can

be studied with the aid of a microscope to determine if they are precancerous or not. Colonoscopy is similar but

not the same as sigmoidoscopy.

related to which parts of the colon each can examine. Sigmoidoscopy allows doctors to view

only the final two feet of the colon, while colonoscopy allows an examination of the entire

colon, which measures four to five feet in length. Often a sigmoidoscopy is used as a screening

procedure for a full colonoscopy.

150,000 cases per year. 50,000 deaths annually.

#2 cause of cancer mortality in non-smoking males and females.

Good evidence that periodic fecal occult blood testing (FOBT) reduces mortality

from colorectal cancer and fair evidence that sigmoidoscopy alone or in

combination with FOBT reduces mortality.

16% of colorectal cancers prevented with FOBT.

34% of colorectal cancers prevented with flex able sigmoidoscopy.

75% prevented with colonoscopy. Colonoscopy q 10 years was more cost-

effective than flex sigs q 5-10 (LOE:?).

Mostly for screening. Should consider colonoscopy if: previous

polyps, family history of colon cancer, rectal bleeding, hemoccult positive stools,

change in bowel habits, protracted diarrhea, surveillance in UC/Crohn’s,

anemia, unexplained wt. Loss/fevers, abdominal pain.

ABSOLUTE Acute, severe cardiopulmonary disease.

Inadequate bowel preparation. Active diverticulitis

Acute abdomen. History of SBE or prosthetic valves with

no prophylaxis. Marked bleeding dyscrasia.

RELATIVE Recent abdominal surgery (bowel or pelvic).

Active infection Pregnancy.

Light source Suction apparatus

Biopsy forceps K-Y Jelly

4X4 inch gauze pads Non-sterile gloves

Water container (for suction)

Video unit and monitor Anoscope Basin of water Formalin jars Disinfecting cleaner

Bowel perforation (1/10000) Bleeding (increased risk with biopsy) Abdominal distention and pain Infection (SBE, infection from another

patient.) Vasovagal symptoms Missed disease

Watch out for patients with previous bowel or pelvic surgery, irradiation, or

diverticulosis. Caution with blind advancement (only

limited distances).

Signed informed consent 2 fleets enemas (one 90 minutes prior,

and one 30 minutes) before procedure Clear liquids after evening meal

Take laxative if chronic constipation Take normal medications (caution with

diabetics)

Beverages: carbonated, coffee, kool-aid (avoid red), tea.

Desserts: Jello, clear popsiclesFruit: Apple juice, cranberry juice,

grape juiceSoups: Beef bouillon, clear brothSweets: hard candy, sugar.

Patient placed in left lateral decubitus position

Rectal examination first Lubrication is key, don’t smear the lens

Either directly insert scope, or flex index finger behind the scope.

Hold scope in left hand, use thumb for up and down, use right hand for right-left (or

can also use thumb).

Insert scope 7-15cm, insufflate and/or withdraw to visualize lumen

Normal rectal mucosa is a nonfriable, vascular network.

Proctitis produces an erythematous, friable mucosa, often with bleeding.

Semilunar valves of Houston appear as sharp edges protruding into the lumen (there are 3)

with shadows noted behind them.

Ulcerative colitis will produce erythema, friability, and mucosal

bleeding.

Redundant folds, hard to visualize lumen

May have to: insufflate, extensive turning, torquing, accordionization, or

dithering Avoid bowing out.

FIGURE 1.Hooking and straightening technique used to pass through a tortuous sigmoid colon. (A) The scope is inserted to the angled sigmoid. (B) The scope tip is turned to a sharp angle, and the sigmoid is hooked as the scope is withdrawn. (C) The sigmoid is straightened as the scope is withdrawn. The scope can then be inserted through to the descending colon.

FIGURE 2.Paradoxic insertion. (A) The scope is bowing out the sigmoid colon, which has a mobile mesenteric attachment. (B) Paradoxic insertion describes the insertion of the tube without advancement of the scope tip. Paradoxic insertion can be very uncomfortable for the patient.

Long, straight tube with concentric haustrae.

Vascularity is random, reticular. Polyps can either be mound-like

(sessile) or on a long stalk (pedunculated).

Don’t mistake suction polyps or mucous for polyps!!

Accomplished by turning inner knob all the way “up” and outer knob all the

way “right” while gently inserting and rotating 180 degrees.

Make sure you are in rectum, and not to far from internal sphincter.

Suction air out before terminating procedure!