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SUBMARINE COLONOSCOPY 7 лет назад

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SUBMARINE COLONOSCOPY

PREPARE TO DIVE! The attached video shows 3 cases where water assisted colonoscopy was used to reach the caecum. I like the term “submarine colonoscopy” as used in the old literature (see below). In one of these cases, there was sigmoid diverticular disease and in another case the patient had had a hysterectomy, both well known enemies of the colonoscopist. Most of the pain during colonoscopy insertion is felt at the passage of the sigmoid colon and at the sigmoid-descending colon junction. The sigmoid colon is suspended in the abdominal cavity by mesentery and is not fixed directly to the retroperitoneum. It is mobile, and, in the left lateral position, infused air collects in the sigmoid colon pulling it up to the right side of the body. The sigmoid is also lengthened thus facilitating loop formation. These days, with the advent of foot operated water pumps, it has become quite fashionable to use water-assisted colonoscopy to facilitate the passage of the scope, particularly through the left colon. The idea is to reduce looping/ stretching of the sigmoid colon thereby reducing pain. The technique is not a modern invention and was first described by Japanese endosocopists in the 1980’s and 1990's (1-5). Some of these early papers were in Japanese and overlooked by Western endoscopists. The early pioneers used terms such at “water-navigation colonoscopy,” “submarine colonoscopy” (my favourite) and “collapse-submergence colonoscopy.” In modern literature, water-aided insertion techniques have been broadly divided into "water immersion" and "water exchange." (6-8) Water immersion (AKA infusion or instillation): water is infused as an addition to gas insufflation, which is used when strictly necessary. It is an unstandardised technique. Air pockets can be used to bypass bowel content. Unclean water is aspirated as needed to allow a safe progression during insertion. Most of the infused water is removed during withdrawal. Water exchange is a more standardised technique. Infusion of water and simultaneous suction of gas results in substitution colonic content with a layer of clear water, allowing gas-less instrument insertion to the cecum without colonic elongation and maximising cleanliness during insertion. With both of these techniques, withdrawal is carried out using gas insufflation. Endoscopists have also used hybrid techniques which combines these two methods. The views are generally limited on insertion using water-assisted colonosocopy and most of the looking is done during the withdrawal phase. REFERENCES 1. Sakai Y. Colon examination and diagnosis with colonoscopy. Gastroenterological Endoscopy. 1988;30(Suppl.1):2925-7 (in Japanese). 2. Abe K, Hara S, Takada Y, et al. A Trial on water pouring method during colonoscopic insertion. Yakuri to Chiryo. 1986;14 (Suppl.1):108-12 (in Japanese with English abstract). 3. Sekioka T, Kosuga T, Endou K, et al. A new insertion technique of the colonoscopy: The submarine method. Gastroenterol Endosc. 1990;32:1461-8 (in Japanese with English abstract). 4. Mizukami T, Yokoyama A, Imaeda H, et al. Collapse-submergence method: simple colonoscopic technique combining water infusion with complete air removal from the rectosigmoid colon. Dig Endosc. 2007;19:43-48. 5. Mizukami T and Hibi T, American Journal of Clinical Medicine 144, Special Issue 2010, 7(3): 144-146, How I Teach My Trainees “Water Navigation Colonoscopy” 6. Cadoni S, Leung FW, Radaelli F: Methods and techniques for unsedated colonoscopy: a systematic review. J Interv Gastroenterol 2015; 5: 25–31. 7. Cadoni S, Leung FW: Water-assisted colonoscopy. Curr Treat Options Gastroenterol 2017; 15: 135–154. 8. Cadoni S, Falt P, Rondonotti E, et al: Water exchange for screening colonoscopy increases adenoma detection rate: a multicenter, double-blinded, randomized controlled trial. Endoscopy 2017; 49: 456–467.

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