Curbside Consultation in Endoscopy: 49 Clinical Questions, Second Edition

Joseph Leung, MD; Simon Lo, MD

Question 18: I Had A Difficult Colonoscopy And No Matter What I Tried, I Just Could Not Reach The Cecum. I Maxed Out On Iv Sedations And Have No Anesthesiology Support. Can You Help Me? (continued)

Felix W. Leung, MD, FACG

It sounds like you are describing what most colleagues consider a difficult colonoscopy. From your comment of “no matter what I tried,” I assume you have already adhered to the use of minimal air insufflation, appropriate loop reduction, use of abdominal compression, and changing patient position. If these indispensable maneuvers for optimizing success with any method to aid insertion have not been used, try them before considering other measures. I have been interested in difficult colonoscopy, especially in unsedated patients, since 2002. I found a plethora of reports that I…