Ever wanted to do a dazzling wrestling move during a colonoscopy list? If the answer is "yes,” then read on…

Intubation of the terminal ileum (TI) is a definitive marker of a complete colonoscopy, especially when there is uncertainty about caecal landmarks. TI intubation can be difficult at times. The standard method for intubation is usually effective; however, an ileal orifice that is acutely angulated can be difficult to identify in the forward view. Standard manoeuvres can lead to unsuccessful, blind attempts at withdrawing the colonoscope tip along the cecal wall. An alternative method for intubating the TI involves retroflexing the tip of the colonoscope in the caecum and is known somewhat colourfully as the “moonsault” technique (1). Moonsault refers to the wrestling move (2) where the protagonist faces away from his adversary (who is usually lying supine in the middle of the ring) and performs a spectacular backward flying somersault by bouncing off the ropes and landing on top of the hapless opponent! Ouch!!

The short video shows both moonsault and standard methods for intubating the TI. With the moonsault technique, the colonoscope is retroflexed in the caecum by simultaneous manipulation of the angulation controls and application of torque to the insertion tube.The lips of ileocaecal valve (ICV) can then be seen en face, usually in the lower part of the screen. The colonoscope is pulled back, and by using this manoeuvre the scope falls into the ICV allowing for insertion. The dials are then returned to a neutral position and we are able to push forward and continue the examination of the ileum. However, the ileal orifice can sometimes be closed and resistant to direct intubation in retroflexion. In this situation, a modified moonsault technique can be employed: a closed biopsy forceps or a snare catheter are first advanced onto the ICV, which may stimulate it to open (3). The colonoscope is then railroaded into the terminal ileum while withdrawing the forceps/catheter.

REFERENCES

1. Coronel E, Singh A, Sakuraba A., Gastrointest Endosc. 2016 Mar;83(3):663. The "Moonsault" maneuver: retroflexed ileocecal valve insertion.
[ Ссылка ]

2. Wrestling Moonsault
[ Ссылка ]

3. Sakata S, Stevenson AR, Naidu S, Hewett DG
Am J Gastroenterol. 2017 Jan;112(1):11-12.Techniques for Terminal Ileal Intubation at Colonoscopy When Standard Maneuvers Fail.
[ Ссылка ]

свернуть