Colonoscopy procedural skills and training for new beginners

Abstract

The incidence of colorectal cancer has been increasing in the developed world including South Korea and China. Colonoscopy allows for greater diagnostic specificity and sensitivity compared with other types of examinations, such as the stool occult blood test, barium enema, and computed tomography colonography. Therefore, in recent years, the demand for colonoscopies has grown rapidly. New beginners including primary care physicians may help meet the increasing demand by performing colonoscopies. However, it is a challenge to learn the procedure due to the long learning-curve and the high rate of complications, such as perforation and bleeding, as compared to gastroscopy. Thus, considerable training and experience are required for optimal performance of colonoscopies. In order to perform a complete colonoscopic examination, there were a few important things to learn and remember, such as the position of examinee (e.g., left and right decubitus, supine, and prone) and examiner (two-man method vs one-man standing method vs one-man sitting method), basic skills (e.g., tip deflection , push forward and pull back, torque, air suction and insufflation), advanced skills (e.g., jiggling and shaking, right and left turn shortening, hooking, and slide-by technique), assisting skills (e.g., position change of examinee, abdominal compression, breathing-holding, and liquid-infusion technique), and intubation techniques along the lower gastrointestinal tract. In this article, we attempt to describe the methods of insertion and advancement of the colonoscope to the new beginners including primary care physician. We believe that this article may be helpful to the new beginners who wish to learn the procedure.

Changing from two‐ to one‐operator colonoscopy insertion technique is feasible with similar quality outcomes

“…In this study, colonoscopy quality outcomes were not compromised with different insertion methods when performed by a single operator in the real world; this finding suggests that the performance of the endoscopist is a key factor in the insertion method to achieve a high‐quality colonoscopy . Second, the study is retrospective in nature, and all patients received analgesia for colonoscopy; hence, information regarding patient discomfort during the procedure was not recorded, and we were unable to analyze the impact of different insertion methods on patient discomfort . Third, the study did not aim to evaluate the learning curve of changing from 2OP to 1OP.…”

“…In early days, colonoscopes were long and rigid, and two operators (two‐operator method [2OP]) were required to control the scope. With improvements in colonoscope design, colonoscopy is increasingly performed by a single endoscopist (one‐operator method [1OP]), who holds and adjusts the colonoscope using right–left and up‐down knobs to control shifting during the entire procedure . Although 1OP is the standard practice in the United States and Japan, 2OP is still commonly used in other parts of the world …”

“…Although use of 1OP can save manpower required for endoscopy and improve patient discomfort, few studies have compared these two methods and published controversial findings on the use and effects of 1OP or 2OP on colonoscopy quality outcomes . Learning to perform colonoscopy usually begins with observation, followed by colonoscopy simulators or practice under supervision with a senior endoscopist to obtain appropriate professionality . Colonoscopists who start with either 1OP or 2OP usually maintain the same practice patterns in their future career, which explains why 2OP is still commonly used by endoscopists who were trained with 2OP in the 20th century .…”

(Technically) Difficult colonoscope insertion – Tips and tricks

“…The most common sites for abdominal compression are the sigmoid colon, sigmoid‐descending junction and transverse colon. Pressure over the suprapubic area, when the straightened colonoscope tip is 20–30 cm from the anal verge or left lower quadrant pressure as the instrument is progressing toward the splenic flexure or transverse colon, may reduce loop formation . Transverse colon loops can be countered by upward pressure across the mid or lower abdomen.…”

“…Pressure over the suprapubic area, when the straightened colonoscope tip is 20-30 cm from the anal verge or left lower quadrant pressure as the instrument is progressing toward the splenic flexure or transverse colon, may reduce loop formation. 13 Transverse colon loops can be countered by upward pressure across the mid or lower abdomen. With the instrument tip in the ascending colon, pressure on the right lateral abdomen or upward pressure under the cecum may be decisive.…”