Colonoscopy procedural skills and training for new beginners

The incidence of colorectal cancer has been increasing in the developed world including South Korea and China.Colonoscopy allows for greater diagnostic specificity and sensitivity compared with other types of examinations,such as the stool occult blood test,barium enema,and computed tomography colonography.Therefore,in recent years,the demand for colonoscopies has grown rapidly.New beginners including primary care physicians may help meet the increasing demand by performing colonoscopies.However,it is a challenge to learn the procedure due to the long learning-curve and the high rate of complications,such as perforation and bleeding,as compared to gastroscopy.Thus,considerable training and experience are required for optimal performance of colonoscopies.In order to perform a complete colonoscopic examination,there were a few important thingsto learn and remember,such as the position of examinee(e.g.,left and right decubitus,supine,and prone)and examiner(two-man method vs one-man standing method vs one-man sitting method),basic skills(e.g.,tip deflection,push forward and pull back,torque,air suction and insufflation),advanced skills(e.g.,jiggling and shaking,right and left turn shortening,hooking,and slide-by technique),assisting skills(e.g.,position change of examinee,abdominal compression,breathing-holding,and liquid-infusion technique),and intubation techniques along the lower gastrointestinal tract.In this article,we attempt to describe the methods of insertion and advancement of the colonoscope to the new beginners including primary care physician.We believe that this article may be helpful to the new beginners who wish to learn the procedure.

Technical skills and training of upper gastrointestinal endoscopy for new beginners

The incidence of gastric cancer remains high in SouthKorea.Upper gastrointestinal(GI) endoscopy,i.e.,esophagogastroduodenoscopy(EGD),has a higher diagnostic specificity and sensitivity than the upper GI series.Additionally,EGD has the ability to biopsy,through taking a tissue of the pathologic lesion.Successful training of EGD procedural skills require a few important things to be learned and remembered,including the posture of an examinee(e.g.,left lateral decubitus and supine) and examiner(e.g.,one-man standing method vs one-man sitting method),basic skills(e.g.,tip deflection,push forward and pull back,and air suction and infusion),advanced skills(e.g.,paradoxical movement,J-turn,and U-turn),and intubation techniques along the upper GI tract(e.g.,oral cavity,pharynx,larynx including vocal cord,upper and middle and lower esophagus,gastroesophageal junction,gastric fundus,body,and antrum,duodenal bulb,and descending part of duodenum).In the current review,despite several limitations,we explained the intubation method of EGD for beginners.We hope this will be helpful to beginners who wish to learn the procedure.

Colonic mucosa-associated lymphoid tissue lymphoma identified by chromoendoscopy

Colonic mucosa-associated lymphoid tissue (MALT) lymphomas are a rare occurrence and the definitive treatment has not been established. Solitary or multiple, elevated or polypoid lesions are the usual appearances of MALT lymphoma in the large intestine and sometimes the surface may reveal abnormal vascularity. Herein, we report a case of MALT lymphoma and review the relevant literature. Upon colonoscopy, a suspected pathologic lesion was observed in the proximal transverse colon. The lesion could be distinguished more prominently after using narrow-band imaging mode and indigo carmine-dye spraying chromoendoscopy. Histopathologic examination of this biopsy specimen revealed lymphoepithelial lesions with diffuse proliferation of atypical lymphoid cells effacing the glandular architecture and centrocyte-like cells infiltrating the lamina propria. Immunohistochemical analyses showed that tumor cells were positive for CD20 and Bcl-2e, and negative for CD10, CD23, and Bcl-6. According to Ann-Arbor staging system, the patient had stage IIE. A partial colectomy with dissection of the paracolic lymph nodes was performed. Until now, there is no recurrence of lymphoma at follow-up.