Structured Approach to Colonoscopy Technique Optimization: A Single-Center Experience with Novice Endoscopists

Summary

This study presents an effective approach to performing colonoscopies. Achieving success in this procedure involves ensuring thorough bowel preparation, carefully inserting the scope while minimizing air insufflation, and skillfully managing any looping of the instrument.

Abstract

A colonoscope is a vital instrument used in performing colonoscopies, with the goal of identifying pathology such as ulcers, inflammation, polyps, and tumors. For screening colonoscopies to effectively reduce the incidence of colon cancer, they must be conducted with high precision and quality. However, for beginners with limited experience, achieving a successful colonoscopy can be a significant challenge. Due to a lack of skill, the success rate of reaching the cecum may be lower, and it is often difficult for novices to become proficient in a short period of time.

During colonoscopy, the equipment can stretch the colon, potentially causing local spasms and distension, which may lead to discomfort in patients, including discomfort and pain, issues that can impede the procedure's progress when conducted by less experienced practitioners.

At our center, we have performed tens of thousands of colonoscopies, and currently, about 98% of these procedures successfully reach the cecum. For doctors who are still developing their colonoscopy skills, it is crucial to focus on honing their technique. Therefore, this study aims to analyze and share insights into effective colonoscopy techniques, providing a valuable learning experience for those training in this field. The following section explores critical insights and implementation experiences related to these methodologies.

Introduction

Cancer, the world's second leading cause of death, poses a significant threat to people's lives and health^1,2. Colonoscopy is considered the "gold standard" for diagnosing issues in the colon and terminal ileum, such as ulcers, inflammation, polyps, and tumors. Beyond its diagnostic capabilities, colonoscopy also serves a therapeutic role³. This study focuses on enhancing the success rate of colonoscopies performed by beginners, who often struggle to improve their proficiency and efficiently complete the procedure.

A colonoscope is a thin, fle....

Protocol

This study was approved by the Shanghai Civil Aviation Hospital Committee (Ethics Approval No: 2023-02). This work was supported by the Scientific Research Project of Health and Wellness Committee, Changning District, Shanghai (No. 2023QN30), and the Foundation of Shanghai Civil Aviation Hospital Project (No. 2024mhyk001).

NOTE: Figure 1 shows the different regions observed under a colonoscope.

1. Preoperative preparation

1. Arrange for the patient to consume laxatives to ensure proper bowel preparation.
2. Instruct the patient to fast for 8 h before ....

Results

Over the course of approximately 1 month, we conducted more than 1,600 colonoscopies, including around 1,400 with anesthesia and 200 without. The average patient age was approximately 48.9 years, with the majority being women. We achieved a success rate of about 98.4% in reaching the ileocecal region. The average procedure time was 9 min, and postoperative patient discomfort was reported in less than 5% of cases (Table 1).

Discussion

Colonoscopy is a complex procedure that can be influenced by various factors. The technique can vary significantly between procedures, and there is always a risk of colonic perforation¹². Colonoscopy varies greatly from procedure to procedure, and there is a risk of perforation and tearing of the colonic belt. Previous studies have identified three anatomical factors contributing to lower success rates in cecal intubation: a lengthy bowel, an angular sigmoid colon, and abdominal wall hernias

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
Dyclonine Hydrochloride	Yangzijiang Pharmaceutical Group	N/A	0.1 g
Olympus CF-HQ290L/I Video Colonoscope	Olympus (China) Co., Ltd.	CF-HQ290L/I
Olympus EVIS LUCERA ELITE CV-290 Video Processor System	Olympus (China) Co., Ltd.	CV-290
Olympus GIF-HQ290 Video Gastroscope	Olympus (China) Co., Ltd.	GIF-HQ290
Physiological saline	Chenxin Pharmaceutical Co., Ltd	N/A	100 mL
Propofol	Chenxin Pharmaceutical Co., Ltd.	N/A	0.2 g
Simethicone Powder	Zigong Honghe Pharmacy Co., Ltd.	N/A	5 g