Thread by @DCharabaty

@stevenbollipo @GutGirlMD @KapuriaMd @renumathyd @BilalMohammadMD @DrDeborahFisher @rodriguezparra_ 1/ Couldn’t agree more with these tips for good colonoscopy ! My top tips: 1- take your time in the sigmoid, put enough air/ water to see where you are going (the more air you put, the further the cecum will be, just like inflating a balloon);

@stevenbollipo @GutGirlMD @KapuriaMd @renumathyd @BilalMohammadMD @DrDeborahFisher @rodriguezparra_ 2/ Reduce Reduce Reduce: Reduce when you reach the splenic flexure, your scope should be at 50; Reduce at turns: hook the tip at the turn and straighten your scope; For a big loop in addition to torquing, flip the scope to make that alpha loop outside the colon on the stretcher

@stevenbollipo @GutGirlMD @KapuriaMd @renumathyd @BilalMohammadMD @DrDeborahFisher @rodriguezparra_ 3/ Ask for the right pressure: at the splenic flexure, get pressure in LLQ (sigmoid); at the mid transverse dip, pressure in LLQ and mid/epigastric to lift that dip. These spots works most of the times, but not all colon are the same, and some needs different pressure points

@stevenbollipo @GutGirlMD @KapuriaMd @renumathyd @BilalMohammadMD @DrDeborahFisher @rodriguezparra_ 4/ Know when to let go of pressure ! Letting go helps the scope move from the ascending colon into the cecum. And the nurse and tech will thank you, holding pressure is tough isotonic work on the arms and backs of your team !

@stevenbollipo @GutGirlMD @KapuriaMd @renumathyd @BilalMohammadMD @DrDeborahFisher @rodriguezparra_ 5/ You put air in to see, you suction air out to move in faster ! Suction the air if the lumen is too distended as you are moving in transverse colon; Little repeated suctions as you move the tip of the scope across a turn

@stevenbollipo @GutGirlMD @KapuriaMd @renumathyd @BilalMohammadMD @DrDeborahFisher @rodriguezparra_ 6/ Don’t waste time with puddles of water as you are going in, as long as you see lumen, you don’t need to suction the water. It will likely not be there when you are pulling back ! (Make sure you are not wearing your favorite shoes :) although I scope best in heels 👠😀

@stevenbollipo @GutGirlMD @KapuriaMd @renumathyd @BilalMohammadMD @DrDeborahFisher @rodriguezparra_ 7/ A well reduced scope = cecum (another good place to reduce BTW) at 60-70. Which means: patient is comfortable; lower risk of complications; you won’t repeatedly fall back and have to go back in to examine an area on withdrawal; you can remove large polyp with a stable scope

@stevenbollipo @GutGirlMD @KapuriaMd @renumathyd @BilalMohammadMD @DrDeborahFisher @rodriguezparra_ 8/ Get into the habit of getting into the TI, even for a screening colonoscopy; you will need that skill when evaluating anemia, diarrhea, abdo pain, weight loss... and sometimes you might save someone’s life by finding an asymptomatic carcinoid !

@stevenbollipo @GutGirlMD @KapuriaMd @renumathyd @BilalMohammadMD @DrDeborahFisher @rodriguezparra_ 9/ Don’t go into TI blindly: best position is 12 o’clock. Find the valve lips, move your tip up in between the lips, puff air and you will be there! Another good position is 9 o’clock, Worst is 6 o’clock (scope doesn’t bend down as easily as up). Easy and steady does it !