Method for performing colonoscopy

Abstract

FIELD: endoscopy; proctology.SUBSTANCE: used to examine the colon mucosa during colonoscopy. When the colonoscope is brought to the haustric folds or to the folds in the area of the anatomical bends of the colon, a flexible three-fingered endoscopic retractor, as in Fig. 1, is inserted into the intestinal lumen through the instrument channel of the colonoscope in a folded form. Then, by manipulating the distal end of the endoscope and the retractor, the endoscopic retractor is moved beyond the visualized fold and the retractor is opened until resistance is encountered. Having fixed the fingers of the retractor in the desired working position using the clamp on the handle, begin to pull the retractor towards one’s self, thereby everting the fold. The mucosal areas behind the fold are examined, then the retractor is folded and removed into the instrument channel, and the colonoscope is brought out distally into the intestine.EFFECT: method increases the efficiency and accuracy of examination of hidden areas of the mucous membrane behind the haustric folds and in the area of anatomical folds of the colon due to controlled eversion of the folds of the colon and an increase in the field of view using a retractor.1 cl, 7 dwg, 1 ex

Description

[0001] The invention relates to the field of medicine, namely to intraluminal diagnostic endoscopy, and is used as an alternative to the conventional technique for examining the colon mucosa during colonoscopy.

[0002] Colonoscopy is the "gold standard" for diagnosing colon cancer. Screening colonoscopies miss nearly a quarter of tumors. Today, a wide range of additional techniques are available to improve the quality of colonoscopy. These include image-enhanced endoscopy (IEE) and field-of-view enhancement technologies.

[0003] Image enhancement technologies include chromoscopy and virtual chromoscopy, including NBI, FICE, AFI, i-scan.

[0004] Special devices that smooth the colonic mucosa during colonoscope advancement (Endocuff, Endocuff Vision (Fig. 7), Endorings) increase the field of view. These attachments are permanently attached to the distal end of the colonoscope and facilitate the exposure of previously inaccessible mucosal areas by passively straightening deep colonic folds, increasing the likelihood of detecting colonic pathologies. The elastic fingers of these attachments, by straightening the folds, enable a detailed examination of every centimeter of the colonic mucosa, enabling the detection of even the smallest neoplasms located behind deep folds. These attachments were selected as a prototype.

[0005] Despite the revolutionary design, such attachments have disadvantages, such as the occurrence of extended damage to the mucosa and erosions during their use, difficulties in intubation of the cecum and terminal ileum.

[0006] The fingers of these attachments, constantly raised to the working position during colonoscope insertion, when the colonic lumen cannot be fully expanded with air (carbon dioxide) to avoid overstretching, catch on the colonic walls and cause unnecessary trauma to the mucosa. Therefore, as the colonoscope advances through the colon, the attachments fail to fulfill their primary purpose.

[0007] It's important to note that not all areas of the colonic mucosa are accessible for inspection when the colonoscope is withdrawn. Therefore, even when withdrawing the colonoscope, the endoscopist may not always need to raise their fingers to the working position.

[0008] From all of the above, it follows that the position of the fingers of the device that increases the field of view during colonoscopy should be controlled by the endoscopist as necessary.

[0009] The objective of the invention is to increase the efficiency of endoscopic examination of the colon.

[0010] The technical result consists in providing the possibility of increasing the field of view when performing colonoscopy for examining the mucosa behind the haustric folds and in the area of ​​the anatomical bends of the colon.

[0011] This is achieved due to the fact that in the proposed method for increasing the field of view when performing a colonoscopy for a thorough examination of the mucosa behind the haustral folds and in the area of ​​the anatomical bends of the colon, a flexible endoscopic instrument is used - a three-fingered retractor (Fig. 1, Fig. 2), passed through the instrument channel of the colonoscope, ensuring smoothing of the mucosa and facilitating maneuverability in the anatomical bends of the colon when removing the colonoscope.

[0012] Images explaining the essence of the invention:

[0013] Fig. 1 - three-fingered endoscopic retractor for increasing the field of view during colonoscopy

[0014] Fig. 2 - three-fingered endoscopic retractor in the working (open) position in the frontal projection

[0015] Fig. 3 - the endoscopic retractor is inserted behind the haustric fold

[0016] Fig. 4 - the endoscopic retractor is opened until resistance appears and is fixed

[0017] Fig. 5 - the endoscopic retractor is pulled up to the fold

[0018] Fig. 6 - further pulling of the endoscopic retractor leads to eversion of the fold, which allows examination of the mucosa behind this fold

[0019] Fig. 7 - Endocuff Vision attachment

[0020] To increase the field of view during colonoscopy for examination of the mucosa behind the haustric folds and in the area of ​​anatomical flexures of the colon, a flexible endoscopic instrument—a three-fingered retractor—is used. The endoscopic retractor has a proximal section—a handle with a clamp for fixing the fingers in a specific working position—and a distal section consisting of three parallel flexible strings that fold into fingers when in use, resembling the spokes of an open umbrella. These serve as supporting and gripping functions, and the retractor ends in a rounded tip, eliminating the risk of perforation when resting against the intestinal wall.

[0021] The proposed method for increasing the field of view during colonoscopy consists of the following steps:

[0022] The primary examination and inspection of the colonic mucosa begins with the colonoscope being withdrawn. Examination of the mucosa behind deep haustric folds and in the area of ​​anatomical flexures of the colon is difficult; in such cases, the proposed endoscopic three-fingered retractor is used. The endoscopic retractor is inserted into the lumen of the colon through the instrument channel of the colonoscope. By manipulating the distal end of the endoscope and the retractor, the endoscopic retractor is advanced beyond the visualized high fold (Fig. 3), after which the instrument is opened until resistance is encountered (Fig. 4). The force of the retractor's fingers pressing on the colonic wall is felt on the handle of the opening instrument, allowing this pressure to be monitored. Having fixed the fingers of the retractor in the desired working position using the clamp on the handle, begin to gradually and carefully pull the retractor towards you, thereby everting the fold, which allows you to examine the areas of the mucosa behind the fold (Fig. 5, Fig. 6).

[0023] By maneuvering the endoscope and retractor, deep folds and creases in the anatomical flexures of the colon are smoothed out, thereby expanding the field of view available for examination. The fingers of the endoscopic retractor, by smoothing out the folds, provide a better view and the ability to examine every centimeter of the colonic mucosa. When examining sections of the colon with shallow folds, the retractor is folded and retracted into the instrument channel, and removed if necessary.

[0024] Thus, previously inaccessible areas of examination are opened by straightening out deep folds of the colon, thereby reducing the time of the examination and increasing the likelihood of detecting even small neoplasms of the colon.

[0025] Clinical case:

[0026] Date: 23.07.2025

[0027] Department: TO

[0028] Patient name: H

[0029] Date of birth: H

[0030] Video colonoscopy

[0031] Preparation: R-3, T-3, L-3.

[0032] The sphincter is tonic. The colonoscope was advanced into the dome of the cecum and then 20 cm proximal to the Bauhinian valve into the ileum. The sigmoid colon was passed on the left side. The small intestinal mucosa is unchanged. The dome is not deformed. The Bauhinian valve is labial. Intestinal tone is markedly increased, resulting in high folds in all sections of the colon, which is why the examination was performed using an endoscopic three-fingered retractor. The mucosa of the examined sections of the colon is pink and shiny, the vascular pattern is preserved, and the folds are pronounced and can be straightened with air. Diverticula up to 8 mm in diameter without signs of inflammation are detected in the sigmoid colon. The lumen corresponds to the examination level.

[0033] In the ascending colon, behind the 2nd and 3rd folds distal to the Bauhinian valve, two epithelial lesions of type 0-IIa, d, measuring up to 4 and 12 mm, with a type II-0 pit pattern according to Kimura were identified. The lesions were removed with a cold loop and submitted for histological examination.

[0034] Conclusion: Hypertensive intestinal dyskinesia. Diverticulosis of the sigmoid colon. Epithelial lesions of the ascending colon have been removed.

[0035] Rec-no: control colonoscopy after 1 year.

Claims

A method for performing a colonoscopy, including the introduction and withdrawal of a colonoscope with an examination of the colonic mucosa, characterized in that when advancing the colonoscope to the haustric folds or to the folds in the area of ​​the anatomical flexures of the colon, a flexible three-fingered endoscopic retractor, as in Fig. 1, is passed through the instrument channel of the colonoscope into the lumen of the intestine in a folded form, then, manipulating the distal end of the endoscope and the retractor, the endoscopic retractor is withdrawn beyond the visualized fold and the retractor is opened until resistance is encountered; having fixed the fingers of the retractor in the desired working position using a clamp on the handle, they begin to pull the retractor towards themselves, thereby everting the fold, they examine the areas of the mucosa behind the fold, then the retractor is folded and removed into the instrument channel, and the colonoscope is withdrawn distally into the intestine.

Images