5.

NEW INSERTION METHOD OF WATER IMMERSION TECHNIQUE

EARLY SHORTENING BY HOOKING ON THE TIP

Water Immersion Technique makes shortening possible, which was difficult with the conventional air insufflation technique. During Water Immersion Technique, the colon is not elongated since the scope and the surface of the colonic wall are lubricated with small amount of water, in other words, the colon is not "shortening-resistant" in this method.

"Early shortening" means shortening of the intestine before the scope reaches the bend or the flexure, that is, the former part of sigmoid or the former part of transverse. Early shortening can be achieved by hooking the tip of the scope on the colonic folds.

TALKING POINTS:

1) Early shortening---shortening the intestine as soon as the scope loses direct advancement or the view starts rotating.

2) Hooking on the tip---even before passing the flexure, it is possible to shorten the colon by hooking the tip of the scope.

WHAT IS EARLY SHORTENING OF THE SIGMOID COLON?

The sigmoid colon is the unfixed portion, therefore when it is pushed it bends in the middle. This bend corresponds to the S-top, and when the tip of the scope is hooked at S-top and pulled to pass SD, it is namely the Pull method. However, in Water Immersion Technique where the colon is deflated and not shortening-resistant, even earlier shortening in the former half of the sigmoid colon is possible. That is called "early shortening".

1) Pulling is typically started at S-top.

2) Early shortening starts withdrawing the scope in the former half of the sigmoid colon.

[Inset 5-1] Early shortening in the sigmoid colon

　

WHAT IS EARLY SHORTENING IN THE TRANSVERSE COLON?

Early shortening is also possible in the transverse colon. In the conventional Pull method, shortening is usually started after the mid-transverse, but in Water Immersion Technique, shortening is started in the former half of the segment, before the mid-transverse colon.

1) Pulling is typically started at the mid-transverse colon.

2) Early shortening starts withdrawing the scope in the former half of the transverse colon.

[INSET 5-2] EARLY SHORTENING IN THE TRANSVERSE COLON

　

WHERE EARLY SHORTENING STARTS IN WATER IMMERSION TECHNIQUE

Sigmoid colon: Shortening should start as early as possible, because there is no apparent peak of the original sigmoid colon. Early shortening can be achieved since the intestine is deflated and not shortening-resistant in Water Immersion Technique. Therefore, suctioning air sufficiently is very important for early shortening.

Transverse colon: There is no tight flexure in the transverse colon, either, before being artificially elongated. Immediately after the splenic flexure, try to shorten the colon with the tip of the scope hooked. Water Immersion Technique in which the intestine is deflated and not shortening-resistant makes it possible to start shortening at this location.

　

　

[MOVIE 5-1]

SUMMARY OF PUSH METHOD, PULL METHOD AND EARLY SHORTENING METHOD

1) PUSH METHOD; Keep pushing into the latter half of the sigmoid colon and resolve the loop after passing SD. Likewise, keep pushing into the latter half of the transverse colon and resolve the loop after passing the hepatic flexure.

2) PULL METHOD; Pushing the scope up to S-top and pass SD with pulling during the latter half of the sigmoid colon. Pushing up to the mid-transverse and pass the hepatic flexure with pulling during the latter half of the transverse colon.

3) EARLY SHORTENING METHOD; Pull the scope and straighten the intestine in the former half of the sigmoid colon. It is commonly used in the Water Immersion Technique in which the colon is deflated and easy to shorten. Likewise, pull the scope in the former half of the transverse colon and straighten the colon.