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World J Gastrointest Endosc. Jul 16, 2023; 15(7): 491-495
Published online Jul 16, 2023. doi: 10.4253/wjge.v15.i7.491
Strategies to manage the difficult colonoscopy
Mike T Wei, Shai Friedland
Mike T Wei, Shai Friedland, Department of Gastroenterology, Stanford University Medical Center, Palo Alto, CA 94306, United States
Author contributions: Wei MT wrote the paper, Friedland S provided editing for paper.
Conflict-of-interest statement: Shai Friedland: Consultant to Capsovision, Intuitive Mike T. Wei: Consultant to Neptune Medical, AgilTx, Capsovision.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Mike T Wei, MD, Clinical Assistant Professor, Department of Gastroenterology, Stanford University Medical Center, 300 Pasteur Drive, Palo Alto, CA 94306, United States. mtwei@stanford.edu
Received: February 26, 2023
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
Core Tip

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).