Letter: Can you have a colonoscopy without sedation?

So what about me? Why did I choose to get sedation? Surely I could have toughed-out the pain of the procedure, right? I truthfully think I would have been fine without sedation. However there is one thing that I've learned from being a physician who does procedures for a living: Sometimes there are unintended bad consequences of going against the standard of care.

Letter: What to do when the colonoscopy prep doesn’t work?

But what if it's too late? If you're reading this while in the midst of a potentially failed bowel prep don't despair! There are many ways to salvage a bowel prep and still have a safe, high-quality colonoscopy the next day. It all depends on what time you take action; If you wait until 2 hours before the procedure is scheduled than nothing can be done, but if you're already having issues the night before you can totally recover from this and be fine. This is what I usually recommend...

Retroflexion in the right colon: Why to do it.

Should retroflexion in the right colon become a routine part of screening colonoscopy? Let's frame this question with the following facts: Colonoscopy is less-protective against right-sided cancers (which implies that colonoscopy is less-effective at finding or removing right-sided polyps...

Retroflexion in the right colon: How to do it.

Since the name of my site is Retroflexions, it's about time I wrote an article about how to retroflex! More specifically, how does one retroflex in the right colon? (Fair warning: This article is probably only interesting to gastroenterologists.)

Retroflexion as a necessary maneuver to resect a large colonic polyp.

Sometimes repositioning the lesion is what it takes to get it done. A better angle between the snare and the polyp can be the difference between sliding over the top or capturing the lesion. In this case, retroflexing the scope in the ascending colon was the key maneuver needed to get the rest of the polyp out.

Tips on handling big polyps that you are not going to remove

Knowing your limits is a very important part of doctoring. As Mark Twain said, "Good decisions come from experience. Experience comes from making bad decisions." Tackling big polyps with the scope is no exception to this rule. Although techniques for removing large polyps have evolved over the years, and maneuvers that were once deemed "high-risk" are now being taught fairly routinely to junior GI fellows, there is still an individual comfort level that practitioners should identify in themselves and respect.

Gastroenterologists are tattoo artists of the colon

It is common practice to leave a permanent tattoo at the site of significant pathology ( such as a large polyp or tumor) inside the GI tract. We typically use a substance called SPOT, which consists of microscopic carbon particles in a suspension. When injected into tissue it becomes a permanent mark that can be seen from the inside of the organ with the scope, and from the outside of the organ by a surgeon.

A simple trick to make taking fiber supplements easier

I find that using a shaker bottle really helps to quickly mix the fiber with water, and also allows for easy re-mixing after you start drinking. These shaker bottles are usually marketed for bodybuilders as a quick and portable way to mix protein powder

How to do a fecal microbiota transplant

This will just be a cookbook-style post on how we do fecal microbiota transplant with colonoscopy. First, a healthy donor must be identified. The donor should be in good general health, since theoretically some problems such as obesity, diabetes, autoimmune disease, etc., may be transmitted by fecal transplant.

The Rectal Bleeding Rainbow

The purpose of this article is to define a few terms and clarify some common misconceptions about rectal bleeding.

Cleaning out the colon, or tips on surviving the bowel prep.

As a patient, you only have control over a few parts of your colonoscopy.  Usually you have a choice of which doctor does the procedure.  You have a choice of showing up on the day of the procedure vs. running in the other direction.  And finally, you have control on how well you are “prepped”  … Read more

Tips for endoscopic placement of nasogastric tubes

Most of the time, nasogastric tubes can be easily passed "blindly" at the bedside without any special equipment or sedation. However, every once in a while, the tube cannot be passed for various reasons, often related to problems in the esophagus such as strictures, tumors, or large hiatal hernias.