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. 1. What is it?
2. Indications
3. Contraindications
4. Preparation
5. Diagnostic Procedures
6. 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. Colonoscopy 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 RisksContra Indications
 Risk of perforation
 Injury 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