Introduction to colonoscopy

Contents 1 Pinyin 2 English reference 3 Overview 4 Operation name 5 Indications 6 Contraindications 7 Supplies and preparation 8 Methods and contents 9 Complications 10 Precautions 11 Post-operation management 1 Pinyin

jié cháng jìng jiǎn chá 2 English reference

Colonoscopy 3 Overview

Colonoscopy is one of the safe, effective, reliable and simple methods for diagnosing and treating large intestine diseases. It not only can It can identify lesions that cannot be identified by barium *** X-ray examination, and can take biopsies for pathological examination and treat certain colorectal diseases. Extensively carrying out this examination can increase the detection rate of early colorectal cancer and provide timely treatment for precancerous lesions and colorectal polyps. 4 Name of procedure

Colonoscopy 5 Indications

Colonoscopy is suitable for:

1. Unexplained lower gastrointestinal bleeding.

2. Chronic diarrhea of ??unknown origin.

3. X-ray barium *** Abnormalities or lesions are found in the examination, but the nature cannot be determined and further diagnosis is required.

4． An abdominal mass cannot exclude disease of the large intestine or terminal ileum.

5. Unexplained low intestinal obstruction.

6. Colonoscopy is required.

7. A follow-up examination is required after colonoscopy.

8. Endoscopy is required after colon surgery.

9. Colon lesions require regular follow-up. 6 Contraindications

1. Suspected large intestine perforation or peritonitis.

2. Severe heart, lung, kidney, liver and mental diseases.

3. People who have undergone multiple laparotomies or have intestinal adhesions should undergo colonoscopy with caution.

4. Pregnancy may lead to miscarriage or premature birth.

5. The acute active phase of large intestinal inflammatory disease is a relative contraindication.

6. For patients with high fever, weakness, severe abdominal pain, and hypotension, it is best to wait until their condition stabilizes before undergoing colonoscopy.

7. Those who are uncooperative and those with insufficient intestinal preparation are relative contraindications. 7 Supplies and Preparations

1. Understand the condition and explain it to the patient? The surgeon should understand the condition (intestinal lesions and systemic organic lesions) in detail, read the barium *** report and X-ray films, and explain the importance and necessity of such examination to the patient. and matters needing attention.

2. Patient preparation

(1) Eat a low-residue diet 3 days before the examination. Those who are undergoing high-frequency electrosurgery should not eat dairy products. On the day of the examination, fasting may be required or liquid food without residue may be taken as appropriate.

(2) Take 30ml of castor oil or other laxative drugs orally before going to bed the day before the examination, and cleanse with warm water 3 hours before the examination***. You can also take 250ml of 20% mannitol orally 3 hours before the examination (not suitable for those who are undergoing high-frequency electrosurgery), and then drink 1000ml of water.

(3) Inject 0.51 mg of atropine or 1020 mg of Lycopodium by intramuscular injection 20 minutes before the examination (avoid for those with glaucoma and prostatic hypertrophy), 510 mg of diazepam (diazepam), or 50 mg of pethidine. Children who cannot cooperate can be given general anesthesia with intramuscular injection of ketamine 46mg/kg.

3. Division of work among examiners? Operator: Operate the colonoscope to adjust the curved corners, observe lesions, take photos and biopsies, etc. Assistant A: Perform auxiliary techniques and cooperate with photography and biopsy. Assistant B: Follow the operator or assistant A’s intention to advance, retreat, and rotate the colonoscope body, pay attention to where the light travels in the abdomen, and report to the operator in a timely manner so that he or she can grasp the direction of the colonoscope. Close cooperation among the three is an important factor in the success of the inspection. It can also be operated by two or one person.

4． Inspection under X-ray fluoroscopy? Those who are skilled in technical operation do not need to conduct the examination under X-ray fluoroscopy. Those who think it is difficult to enter the mirror can also conduct the examination under the monitoring of the X-ray machine screen.

5. Instruments and equipment: Prepare the colonoscope and accessories according to the usual operating procedures. 8 Methods and content

It can be divided into two-person operation or single-person operation under non-fluoroscopy and fluoroscopy guidance.

Remember the key points: "Inject less air, find the cavity carefully, remove the bends and get straight, change the angle, turn sharp bends into slow bends, and move forward along the cavity." Then proceed in the following order:

1. The patient lies in the left lateral decubitus position, and a routine digital examination is performed, except for *** strictures and rectal masses.

2. The basic principle of colonoscopy operation is to insert the scope through the lumen. That is, the scope can only be inserted when the intestinal lumen is visible in the field of view. Otherwise, it needs to be pulled back to find the lumen.

3. There are often several sharply curved intestinal segments during the endoscope, such as the junction of the sigmoid colon and the descending colon, the splenic flexure, and the hepatic flexure. If you have difficulty finding the intestinal lumen, you can follow the direction of the intestinal lumen you see. For sliding insertion, usually the intestinal lumen will appear after sliding for about 20cm; if the intestinal lumen is still not visible after sliding for a long distance, you should withdraw the scope and find another direction before inserting the scope.

4. There should be no obvious resistance when inserting the lens. If there is severe pain, avoid blindly sliding in or violently inserting the lens.

5. After passing through a sharply curved intestinal segment, sometimes the intestinal lumen is visible but still cannot be entered into the scope. On the contrary, sometimes the scope will be withdrawn. At this time, the scope should be withdrawn and the straight scope body should be pulled out with a hook to shorten the intestinal tube. Make the colon straight and the acute angles become obtuse before passing through. If insertion is still difficult, the patient's vagina or abdominal wall pressure can be changed to avoid the generation of conductive fulcrums and resistance.

6. Inject as little air as possible and inhale more during the entire insertion process.

7. The ileocecal valve and appendiceal orifice must be visible in the field of view to consider that the end of the scope has reached the cecum and the insertion was successful.

8. If necessary, 20 to 40cm of the terminal ileum can be inserted through the ileocecal valve.

9. Colonoscopy observation and treatment should start when the endoscope is inserted, but the focus should be on reaching the cecum and retracting the endoscope, and should be carried out in the order of proximal end first and then distal end.

10. When you see a positive lesion, you should take 2 to 4 pieces of biopsy tissue, put 4% formaldehyde (10% formalin solution) immediately, and label it.

11. When writing a report, the location, scope, size, shape, etc. of the positive lesions should be described in detail, and the examination results should be explained. 9 Complications

(1) Perforation: The incidence rate is 0.11% to 0.26%. The most common is sigmoid colon perforation. Once colon perforation is diagnosed, surgery should be performed immediately. Extra-abdominal perforation generally does not require surgery, and requires fasting, fluids, and anti-infective treatment. The perforation will heal on its own after 1 to 2 weeks, and retroperitoneal and subcutaneous emphysema can be absorbed on its own.

(2) Bleeding: The incidence rate is 0.07%, and most of them can be cured through microscopic hemostasis and conservative treatment.

(3) Serosal tear: also called incomplete perforation, it is rare and generally does not require special treatment and will heal on its own.

(4) Intestinal colic: usually caused by vaginal examination, has no special significance and can be relieved by itself.

(5) Cardiovascular accidents: Colonoscopy has an extremely slight impact on cardiovascular disease, and patients with severe coronary heart disease or arrhythmia should be performed with caution.

(6) Respiratory depression: Most of it is related to the preoperative application of sedation or anesthetics. Once it occurs, resuscitation treatment should be carried out immediately. 10 Precautions

When inserting the scope body, please pay attention to:

(1) Follow the principle of inserting the scope through the cavity, and try to avoid the eyelid slipping in to avoid intestinal perforation.

(2) Do not inject too much air. If the abdominal distension is obvious, you need to pump out the air to narrow the intestinal cavity and shorten the intestinal tube to facilitate the endoscopic examination.

(3) Avoid the formation of intestinal loops. For example, the patient feels abdominal pain when entering the mirror, and the pain is relieved when the mirror is withdrawn; the mirror goes backwards when entering; the mirror goes forward when withdrawing; the insertion distance of the scope is too far beyond the expected distance (normal to the B-descended transitional part is 2025cm, the splenic flexure is 40cm, and the hepatic flexure is 60cm) , cecum 80cm), is a sign of intestinal loop formation. At this time, the "hook pull" method should be used to untie the intestinal loops. If it is still difficult to enter the microscope, abdominal manipulation can be used to prevent the loops.

(4) When inserting the scope without X-ray fluoroscopy, you can refer to the shape of the intestinal cavity, the light spot position on the abdominal wall, and pressing the intestinal wall to determine the location of the scope.

(5) If there is severe pain in the left lower abdomen during the examination and the above method still cannot successfully enter the examination, the examination should be stopped to prevent perforation.

(6) Those who have found lesions during the examination but can continue to enter the microscope should continue to the ileocecal part. If there are intestinal adhesions, narrow intestinal lumen or other reasons that make it difficult to enter the microscope, you cannot forcefully ask to be sent to the ileocecal part.

(7) If small lesions are found when entering the microscope, photos and biopsies should be taken in time to prevent the intestinal folds from being missed when the microscope is withdrawn. During the process of withdrawing the microscope for observation, the "retreat and advance" technique should be adopted, and attention must be paid to observing the blind areas behind the hepatic flexure, splenic flexure, and B-descending transition to prevent small lesions from being missed.

(8) The methods of photography, biopsy, and cytology are the same as those of upper gastrointestinal endoscopy.

(9) After finding the ileocecal valve opening, the enteroscope should be inserted into the terminal ileum as much as possible. If the procedure goes well, the scope can be inserted up to 2050cm into the ileum and can detect lesions in the terminal ileum.

11 Post-operation management