Looping and Using External Compression Techniques

Using external compression or splinting techniques can often make the examination much easier (for both the patient and examiner) and in some cases, it may be the only means of completing ileocolonoscopy. Proper use of compression technique requires close cooperation between the examiner and assistant; compression should be performed with targeted, steady pressure without using force. The localization of optimal pressure points is for the most part based on the experience of the examiner and assistant. In some cases, palpation can be used to locate the position of the endoscope or colon. With slender patients in particular, position of the instrument in the colon and incorrect advancement direction can be palpated through the abdominal wall. The use of radiographic screening or other methods (see below) can help determine position and in extreme cases may be necessary for ascertaining the exact position of the endoscope. External hand pressure can be used, in particular, for flexible colon segments, such as the sigmoid colon, transverse colon, and cecum, which are located intraperi-toneally and attached to the posterior abdominal wall by a me-socolon. Retroperitoneally fixed colon segments, such as the ascending colon and descending colon, generally do not require splinting.

A number of variations are possible for using splinting to counteract undesirable bowing or looping and to help straighten the colon. However, for certain difficulties occuring frequently, there are standard techniques that will be described below.

Position Colon

Looping and Using External Compression Techniques

~ |T| 5.1 Illustrated summary of normal examination procedure

~ |T| 5.1 Illustrated summary of normal examination procedure

Normal Sigmoid Colon Sigmoid Colon

Fig. 5.26 Applying pressure over the sigmoid colon.

a Simple pressure over the sigmoid colon in the supine position. b Combined pressure over the sigmoid colon in supine position.

Fig. 5.26 Applying pressure over the sigmoid colon.

a Simple pressure over the sigmoid colon in the supine position. b Combined pressure over the sigmoid colon in supine position.

Sigmoid Straighten Colonoscopy

■ Applying Simple Pressure over the Sigmoid Colon in the Left Lateral Position

At the beginning of the colonoscopy the patient is lying in the left lateral position. After reaching the rectosigmoid junction pressure can be applied to the lower left abdomen to splint the sigmoid colon and avoid the formation of a loop. Changing position is not necessary.

■ Simple and Combined Pressure with Patient in the Supine Position

If applying simple pressure in the left lateral position is difficult (e.g., for adipose patients) or if pressure applied in this position is unsuccessful, it is recommended that the patient should change to the supine position. In this position, pressure on the midabdominal region can fix the flexible sigmoid colon in the lower left abdomen and counteract looping (Fig. 5.26a). The effect is enhanced by additional use of the other hand on the patient's left lateral side, preventing the movement of the sigmoid colon this direction (Fig. 5.26b).

■ Transverse Pressure

The transverse colon, which can vary in the extent to which it droops caudally, in extreme cases hanging down even into the minor pelvis, can pose difficulties for advancing the colono-scope. Along with the flexible sigmoid colon, it can be a further indication for using external hand pressure. Lifting the drooping midtransverse colon segment cranially can straighten the transverse colon and simplify advancement to the hepatic flexure (Fig. 5.27).

■ Pressure on the Right Flank

Applying external pressure to the right flank over the hepatic flexure can be helpful for passing the flexure. This can make turning the endoscope tip around easier as it comes out of the transverse colon and advances caudally in the direction of the colon (Fig. 5.28).

Picture Sigmoid Colon
Fig. 5.28 Applying pressure on the right flank for passing the hepatic flexure.

■ Pressure over the Cecum

In some cases, external pressure applied over the cecum can be helpful for complete inspection of the cecum (especially for a mobile cecum) and for intubation of the ileocecal valve (Fig. 5.29).

Withdrawing the Endoscope and "Blind Spots"

Withdrawing the Endoscope and "Blind Spots"

Picture Sigmoid Colon

Fig. 5.29 Applying pressure over the cecum. Fig. 5.30 Determining endoscope position.

a Using radiography screening for looping in the sigmoid colon (partial image). b Using Scope Guide (Olympus) for computerized three-dimensional positioning (same situation as in a).

Fig. 5.29 Applying pressure over the cecum. Fig. 5.30 Determining endoscope position.

a Using radiography screening for looping in the sigmoid colon (partial image). b Using Scope Guide (Olympus) for computerized three-dimensional positioning (same situation as in a).

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Responses

  • SHELBY
    What is looping of the colon?
    6 years ago
  • lisa bader
    What is Sigmoid Colon Looping?
    3 years ago
  • Awet
    What causes external compression in the colon?
    3 years ago
  • selassie
    What is external compression cecum?
    2 years ago
  • mary
    How to apply compression of ileocecal valve?
    1 year ago

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