Aside from sheer volume of scopes, any tips for increasing cecal intubation rate and time? What things did you wish you knew earlier in fellowship re colonoscopy that you discovered later with more training? Thank you all for your help!
Colonoscopy Tips
- Thread starter DJ Mobitz
- Start date
- Joined
- Jul 30, 2014
- Messages
- 514
- Reaction score
- 253
consciously recognize loops and reduce once you reach splenic flexure or transverse. it reduces patient discomfort and time to cecum
I learnt water immersion only in 3rd year fellowship and anyone with prior documented redundant colon, I consciously do exclusive water immersion(I turn off air button)
I learnt water immersion only in 3rd year fellowship and anyone with prior documented redundant colon, I consciously do exclusive water immersion(I turn off air button)
- Joined
- Jun 23, 2008
- Messages
- 293
- Reaction score
- 119
Same, I use more water exchange then ever before and sometimes the whole way to the cecum, low threshold to use pressure and position change and consider at times using it prophylactically before you run into loops to prevent, reduce frequently, at the end of the day you will get better yes, but you will regret a missed cancer far more than not being fast enough to squeeze in one more procedure on any given day, so take your time, as much as it takes. If it takes an hour, then take an hour, not because you should but because you can, if that's what it takes to keep someone safe.
- Joined
- Oct 28, 2019
- Messages
- 106
- Reaction score
- 100
Ask senior fellows who the best attendings to work with are. This will be different at different times for fellowship. Some days you want the attending who lets you do it all, when you start you may need that one takes over from you and shows you- don't take it personally its part of your growth and not a bad thing- don't just shy from these attendings because of that. Also ask fellows in your program this same question.
Understand the anatomy early.
Watch some of the senior attendings insert/ withdraw. I still do this. Tons of videos online now too.
First point to understand is getting to cecum early on is NOT the goal. Getting wherever you get to with good technique and straight scope is the key. I'd rather a fellow get to the ascending with 70 of scope and take 15 min than get to cecum in 7 min with 120 of scope in. Can do a thousand colons with bad technique and continue to struggle.
Second key point is similar, focus on good technique. Bad habits are hard to break- get your ergonomics right, dont have an external loop, make sure your check your equipment, towel, monitor/ bed height, lube etc. Make that part of your mental checklist.
Try to hone in on core principles early- the sigmoid sucks, take your time, 2 looks in the right colon, never push blindly etc
Complications are a part of what you signed up for. Recognize them early, know what to do about them.
Seek feedback. Ask questions.
Learn and respect your nurses and techs, do not neglect them. They are an integral part of the procedure, keep constant communication and respect. You will learn a ton from them and they can also give you feedback.
Knowing your tech (scope sizes/ diameters/ channels/ accessories) isn't key first year but you need to really start thinking about it once you've got the basics down
Water immersion as everyone has said. Need to try and master this.
Be cognizant of putting loops, aggressively try to take them out.
Understand where and how to give pressure. Read for sure, but some techs have a gift, ask them too.
Therapeutics shouldn't be something you worry about in first year.
Time is not the focus, finding polyps and protecting from cancer is. Dont skimp on proper withdrawal as the above posters said.
Advanced endoscopy/ therapeutics has more rules, many of these apply, but many more that deserve a separate thread if you want.
Understand the anatomy early.
Watch some of the senior attendings insert/ withdraw. I still do this. Tons of videos online now too.
First point to understand is getting to cecum early on is NOT the goal. Getting wherever you get to with good technique and straight scope is the key. I'd rather a fellow get to the ascending with 70 of scope and take 15 min than get to cecum in 7 min with 120 of scope in. Can do a thousand colons with bad technique and continue to struggle.
Second key point is similar, focus on good technique. Bad habits are hard to break- get your ergonomics right, dont have an external loop, make sure your check your equipment, towel, monitor/ bed height, lube etc. Make that part of your mental checklist.
Try to hone in on core principles early- the sigmoid sucks, take your time, 2 looks in the right colon, never push blindly etc
Complications are a part of what you signed up for. Recognize them early, know what to do about them.
Seek feedback. Ask questions.
Learn and respect your nurses and techs, do not neglect them. They are an integral part of the procedure, keep constant communication and respect. You will learn a ton from them and they can also give you feedback.
Knowing your tech (scope sizes/ diameters/ channels/ accessories) isn't key first year but you need to really start thinking about it once you've got the basics down
Water immersion as everyone has said. Need to try and master this.
Be cognizant of putting loops, aggressively try to take them out.
Understand where and how to give pressure. Read for sure, but some techs have a gift, ask them too.
Therapeutics shouldn't be something you worry about in first year.
Time is not the focus, finding polyps and protecting from cancer is. Dont skimp on proper withdrawal as the above posters said.
Advanced endoscopy/ therapeutics has more rules, many of these apply, but many more that deserve a separate thread if you want.
- Joined
- Jul 8, 2016
- Messages
- 255
- Reaction score
- 206
This was very helpful can you post one for therapeutics
