Colonoscoping the "difficult" colon

Despite the popularity of colonoscopy, very little has been published on specific technique. There are many factors that make colonoscopy easy or difficult, but the most important one is the endoscopist himself/herself. One must have excellent manual dexterity and technical ability; and, above all, one must perform enough cases to gain the needed experience to understand the procedure and to perform it rapidly, successfully, and safely. There are only so many maneuvers that can be carried out with a colonoscope, such as pushing it in, withdrawing it, turning it to the right, left, up, or down. Therefore, decision making (options), such as changing the position of the patient or applying external pressure points, must be performed rapidly before too many repetitive false moves are made. Options for each anatomical segment of the colon are outlined, based on an experience of ten thousand colonoscopies.