Published online Jul 16, 2023. doi: 10.4253/wjge.v15.i7.491
Peer-review started: February 26, 2023
First decision: May 16, 2023
Revised: May 22, 2023
Accepted: June 19, 2023
Article in press: June 19, 2023
Published online: July 16, 2023
Processing time: 133 Days and 23.5 Hours
During endoscopy, an endoscopist is inevitably faced with the occasional “difficult colonoscopy,” in which the endoscopist finds it challenging to advance the endoscope to the cecum. Beyond optimization of technique, with minimized looping, minimal insufflation, sufficient sedation, and abdominal splinting when needed, sometimes additional tools may be needed. In this review, we cover available techniques and technologies to help navigate the difficult colonoscopy, including the ultrathin colonoscope, rigidizing overtube, balloon-assisted colonoscopy and the abdominal compression device.
Core Tip: In all colonoscopies, we recommend optimizing technique, with minimal insufflation, sufficient sedation, minimal looping, water immersion, and having staff apply abdominal pressure when needed. When the cecum cannot be reached despite this, we consider utilization of additional tools, including overtube or specialized endoscope (e.g., ultrathin colonoscope).