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Colon Intubation: Introduction and General Principles

The intubation of the colon, i.e. the progression of the colonoscope from the rectum to the cecum, is the result of a number of maneuvers adopted by the endoscopist, some sequential and some simultaneous. The progression of the scope into a redundant colon requires “shortening” maneuvers in different segments, changes in the decubitus of the patient and frequent torque-steering on the shaft of the colonoscope. Every endoscopist reaches his/her own intubation technique, through a combination of personal attitudes and skills with basic technical steps, adjusted to the characteristics of the endoscopic equipment.

The intubation of the different colonic segments described in the following paragraphs of this section, is based on the personal modality of 4-hands insertion, which combines actions of both operator and nurse assistant. The table reported as Fig. 1 and Fig. 2 show the significance of the symbols in the different steps of scope progression, segment by segment.



Fig. 1: symbols related to the maneuvers applied by the endoscopist to the distal tip of the scope (in blue), torques of the shaft combined to the rotation of the chest (in yellow), the insertion (green arrow) or withdrawal (red arrow) of the colonoscope, and combined movements (yellow and black arrow).

Fig. 2: symbols related to the morphology of the bends to pass (open-obtuse angle or closed-acute angle), to the application of abdominal compression (hand with arrow), to the insufflation or aspiration of the air, or the irrigation of water in the colon.