The Difficult Colonoscopy is humbling to all endoscopists.

My Pearls :

#1 Female Patients
If hysterectomy or diverticulitis, use pedi colonoscope + water immersion. (Angulated colon)

If chronic idiopathic constipation or visceral obese, use adult colonoscope (redundant colon) #2 Hard Turns

At a severe turn, a loop itself may form to obstruct your own view. Try hooking into the turn (ideally big wheel up) and pull back until the lumen winks at you. At that moment, you insufflate and let the scope go, like firing an arrow.

My assessment of the 3 commercially available hemostatic powders:

@CookMedical Hemospray
@OlympusMedUS Endoclot
@MedtronicGI Nexpowder

We will review clogging, deployment ease, learning curve, visualization, safety, powder volume, environmental waste, and cost.

(1/) Efficacy of powders relative to one another are unknown.

Hemospray obviously has the greatest evidence basis including level 1 (RCT) evidence, with non-inferiority to standard therapy.

acpjournals.org/doi/abs/10.732…

And massive post market registry spanning ~10 years.

(2/)

The GI Fanny Pack

I have been wearing one since 2009 on surgery rotation as a student to the chagrin of nearly everyone associated with me. It’s no longer fashion faux pa at least in hipster Austin.

This is what I keep it in it and why.

#GITwitter
#Endohacks
#GiHacks @stevenbollipo @drkeithsiau @VKumbhari @Samir_Grover @BilalMohammadMD @KM_Pawlak @KMonkemuller @NeenaSAbrahamMD @kunjali @TomTielleman @AdvaniRashmiMD @helpatologist @GI_Guy @GIDrDon @AnotherPatelMD @bcm_gihep @DrMohdZein @ZSobaniMD @SighPichamol @EndoscopyOthman @SAGES_Updates