Colonoscopy- A Pictorial Overview

COLONOSCOPY- A PICTORIAL OVERVIEW


• Dear viewers,
• Greetings from “Surgical Educator”
• This week I have uploaded a video on Colonoscopy- the Lower GI Endoscopy.
• In this episode, I showed only the colonoscopic features of common pathologies in colon and rectum.
• I restricted my talk to the essential minimum that an undergraduate medical student must know about the Colonoscopy.
• I discussed about the diagnostic and therapeutic procedures you can do with the Colonoscopy.
• I hope it would be interesting and very useful to all my viewers.
• You can access this video in the following links:
• surgicaleducator.blogspot.com youtube.com/c/surgicaleducator
• Thank you for watching the video.

1. COLONOSCOPY - A PICTORIAL OVERVIEW Prof.Dr.B.Selvaraj MS; Mch ; FICS; “ Surgical Educator” Malaysia

2. What is it? Indications Contraindications Preparation Diagnostic Procedures Theraputic Procedures COLONOSCOPY

3. 1. Inserting flexible long colonoscope to different parts of large bowel up-to cecum through anal orifice. While withdrawing this scope out, you have to look for any pathology. 2. Experienced examiner can now successfully reach the cecum in 98% of patients. 3 .Difficulties can be posed by a mobile and elongated sigmoid colon or transverse colon as well as by postoperative intestinal fixations and other adhesions. 4.Examination generally takes around 30 minutes. Because of painful nature of this procedure you should try to finish the procedure as early as possible. COLONOSCOPY- Introduction 5.Proper training and experience are necessary for correct diagnosis . 6 . The diagnostic spectrum of colonoscopy encompasses not only macroscopic assessment of the condition of the mucosa, but also the possibility of collecting a targeted biopsy sample and, more recently, the use of dye spraying technique and magnification. 7. C olonoscopy is a technically demanding examination procedure with a high clinical yield combined with the capability of therapeutic intervention.

4. COLONOSCOPY- Indications Constipation Diarrhea Abdominal pain Bleeding per rectum, unexplained anemia, weight loss Postpolypectomy surveillance Prevention/aftercare colorectal carcinoma Pathological thickening of the colon wall detected by other imaging procedures Primary tumor search with metastasizing malignancy. Simbionix computer simulator A Universal cord and plug B Instrument control head, C Insertion tube

5. COLONOSCOPY- Contra Indications Perforated intestine Acute diverticulitis Deep ulcerations Severe ischemic necroses Fulminant colitis Cardiopulmonary decompensation Complications and Risks Contra Indications R isk of perforation I njury to blood vessels causing bleeding Infection Comparing diagnostic and therapeutic colonoscopy, more complications arise from therapeutic measures, such as polypectomies

6. COLONOSCOPY- Preparation Emptying the contents of the colon is a key requirement for a successful colonoscopy. If the bowel prep isn't up to par, polyps and lesions can be missed A few days before the colonoscopy procedure- Start eating a low- fiber diet The day before the colonoscopy procedure - Don't eat solid foods and have clear liquids. The day of the colonoscopy procedure — As on the previous day, clear liquid foods only Don't eat or drink anything two hours before the procedure Now you can give either PEG- Poly Ethylene Glycol or Sodium Picosulphate - Fleet enema Dissolve one pocket of anyone of this in two Litres of fluid and ask patient to consume Patient will purge several times within few hours so that the bowel will get cleaned . Can be done under IV sedation of midazolam/fentanyl or propofol

7. COLONOSCOPY- Preparation

8. COLONOSCOPY- Preparation

9. COLONOSCOPY Five basic rules of colonoscopy 1. Do not advance the endoscope without a clear view of the lumen. 2. Do not advance the endoscope if there is any resistance. 3. When in doubt, pull back. 4. Use as little air as possible and as much air as necessary. 5. Pay attention to patient’s pain reaction.

10. COLONOSCOPY Triangular configuration and evenly spaced haustration . Splenic flexure with luminal impression, shimmering of spleen . Relatively straight path , oval lumen, and evenly spaced haustrations . Roomy lumen Valves of Houston Typical submucosal vascular pattern Lumen cannot be seen at about the 7-o’clock position but can presumed , in part due to shadowing Ascending colon toward the 7-o’clock position. The ileocecal valve, seen as a yellowish,thickened fold , is on the lower edge of the lumen Base of the cecum Appendix orifice in the center Terminal ileum: velvety mucosal surface and lacking haustrations

11. Diagnostic Procedures COLONOSCOPY

12. DIVERTICULOSIS

13. DIVERTICULITIS

14. POLYPS

15. POLYPOSIS

16. CARCINOMA- COLON/RECTUM

17. IBD- Crohn’s & Ulcerative Colitis

18. Angiodysplasia & Radiation Colitis

19. Pseudomembranous & Ischemic Colitis

20. Therapeutic Procedures COLONOSCOPY

21. SNARE POLYPECTOMY

22. Endoscopic Mucosectomy Steps in mucosal resection of broad-based polyps using piecemeal resection technique

23. SEMS- For Malignant Stricture Placement of metal stents combined with balloon dilation or bougienage

24. Hemostasis in Colorectal Pathologies Injection Gold Probe

25. Hemostasis in Colorectal Pathologies Coagulation of an angiodysplasia using APC (ERBE)

26. Hemostasis in Colorectal Pathologies Endoscopic hemoclip application

27. Removing Foreign Bodies

28. Removing Foreign Bodies Colonoscopic removal of Drug pouches- from a bodypacker