Endoscopy

Abstract

The endoscopic evaluation of the patient with colorectal complaints forms the keystone of the physical examination. These examinations allow for the visualization of the entire intestinal tract and include anoscopy, proctoscopy, and colonoscopy as well as PillCam endoscopy. The indications for performing a colonoscopy are multiple, yet there is debate regarding the appropriateness of performing the procedure in some clinical scenarios. The bowel prep is of critical importance in order to adequately examine the entire colon, with inadequate cleaning reported in up to 27% of patients. Splitting the timing of the prep into one half the day prior to and half the day of the procedure results in a better prep. There are several adjunctive maneuvers employed with endoscopy that often serve as the markers between seasoned experts and novices. There are alternate techniques, as well, including CO2 insufflation and narrow-band imaging (NBI) endoscopy and chromoendoscopy. The 30-day complication rate of colonoscopy is low, ranging from 1 to 5 per 1000 examinations. There is debate on the adequate training required before someone is competent to independently perform colonoscopy, and inadequate documentation following the procedure is common. PillCam endoscopy is most commonly employed for patients with occult gastrointestinal bleeding or in the search for other small bowel pathologies, such as insipient tumors, polyposis syndromes, or Crohn’s disease.