EndoQuest: Colonoscopy in the GI Unit

Participants will be able to:

1. Directing the Endoscopy Unit

• Identify key quality metrics and benchmarks used to evaluate endoscopy unit performance, including adenoma detection rate, cecal intubation rate, and on-time starts
• Outline strategies for optimizing patient throughput, staff roles, and resource utilization within the endoscopy unit
• Apply regulatory and accreditation standards to develop and implement endoscopy unit policies and quality improvement initiatives

2. Understand Principles of Electrosurgery Setup

• Explain the fundamental principles of electrosurgical energy, including differences between monopolar and bipolar circuits and cut, coagulation, and blended waveforms
• Identify the components of an electrosurgical unit and describe proper setup, grounding pad placement, and safety precautions
• Select appropriate electrosurgical settings for common endoscopic procedures and recognize strategies to prevent complications such as burns and interference with implanted devices

3. ESD of Large Polyps

• Differentiate ESD from EMR in terms of technique, indications, and outcomes, and identify appropriate candidates based on polyp size, morphology, and location
• Describe the stepwise ESD technique and select appropriate knives, injection solutions, and accessories for procedures in various anatomical locations
• Recognize and manage intraoperative complications of ESD, and interpret pathologic findings to determine curative resection and need for further treatment

4. Basics of Anorectal and Colon Function

• Describe the mechanisms of colonic motility and their role in transit and absorption
• Explain the physiology of defecation, including the roles of the internal and external anal sphincters, puborectalis muscle, and rectoanal inhibitory reflex
• Identify common pathophysiologic mechanisms underlying constipation, fecal incontinence, and anorectal dysfunction and correlate them with basic anorectal manometry findings

5. Challenging Colonoscopy to Cecum

• Identify anatomical and patient-related factors that contribute to difficult colonoscopy and apply loop reduction maneuvers and positional techniques to advance through a tortuous colon
• Select and utilize specialized equipment such as variable stiffness colonoscopes, overtubes, and cap-assisted colonoscopy for challenging cases
• Recognize landmarks confirming cecal intubation and develop a systematic approach for patients with a history of prior incomplete examinations

6. Fecal Transplantation

• Explain the rationale for FMT based on gut microbiome science and identify evidence-based indications, including recurrent Clostridioides difficile infection
• Describe donor selection criteria, stool screening protocols, and available delivery routes including colonoscopy, nasojejunal tube, enema, and oral capsule
• Counsel patients on the benefits, risks, and expected outcomes of FMT and summarize current regulatory and ethical considerations surrounding its clinical use