My approach to water assisted colonoscopy: Keith Siau, Iosif Beintaris
Unless you are an innately skilled endoscopist, learning colonoscopy can be a difficult process for both the trainee, the trainer and even sometimes the patient. The learning curve for me in colonoscopy was a steep one. So often would I be parked up against the bowel wall, unable to visualise anything. A look up at my scope guide would show I had created loops that Pythagoras would have been proud of and feeling dreadful whenever the patient winced with pain.
Despite this difficulty I was blessed with some great trainers, one of the best pieces of advice was to try and do as many things right at the start of a colonoscopy as this can make a dramatic impact on the outcome in terms of ease of progress and comfort in the end.
I am now an ST5 in gastroenterology and only really in the last year has this concept of water assisted colonoscopy really made me sit back and take a look. The principles of it are really quite pleasing for those that think mechanically like I do.
The process of water assisted colonoscopy is exactly what it says on the tin- the water acts as an alternative to air/co2 that enables you to perform a colonoscopy with less need for air or co2. The advantages are this are that the water acts as gravitational force that reduces colonic elongation which has been shown to reduce loop formation, patient discomfort and even sedation requirements.
But there is more, there is evidence that it even improves mucosal views and even adenoma detection rates. As someone whom has recently signed off for colonoscopies there are still many colons that are just hard to get around. In using this new trick or technique I have found another little bit of help that culminates in making big impacts on the end outcome.
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