Colonoscopy is an important procedure for diagnosing and preventing colorectal cancer (CRC), however it can be difficult to perform. Some key challenges include it taking more time than other endoscopic procedures, and having a lower completion rate. Both patient and colonoscopist factors can impact difficulty, such as patient anatomy, BMI, previous operations, and colonoscopist experience and practice volume. New technologies and techniques aim to help overcome challenges and improve adenoma detection rates, including narrow-band imaging, articulating endoscopes, and over-tube devices.

1. Colonoscopy: How to increase its role in diagnosing/ prevention of CRC.

2. Colonoscopy: Solutions & advances. Objectives of colonoscopy. Difficulty of colonoscopy. Summary. 1 2 3 4

3. Introduction The main objectives of colonoscopy is early detection of CRC & their precursors adenomas. CRC is the second leading cause of Ca−related deaths. Adenomas( occur in25% males/ 15% females > 50 ys are the benign precursors of CRC& their removal results in a lower than expected incidence of CRC. Detection of CRC at an early stage improves the prognosis.

4. Colonoscopy is more difficult: Time Less completion More Complex /risky prep 30 mins vs 5 mins. 75% vs nearly 100%. Involving use of strong cathartics. >Time Consuming 30 vs 5 mins Less completion 75 vs 100% More Complex/risky preparation. Difficult colonoscopy: struggling to reach the cecum. Colonoscopy is more difficult than OGD:

5. Difficult colonoscopy: causes Colooscopist factors Patient factors Both Canadian J of GE: August 2007 .

6. Colonoscopist factors: Experience Timing Training Practice volume: Factors Morning vs evening, Early vs late work hours. Manual dexterity. Better with high volume practices. Experience Training/manual dexterity Practice volume Timimg

7. Patient factors: Female SEX: More long, tortuous angulated colon. No ideal BMI: Too fat or too thin. Diverticular disease Previous operation with adhesions. Patient factors:

8. Colonoscopist & patient factors: Preparation: Need good patient-doctor cooperation. Loops & Angulations: Too much air insufulations. Less patient cooperation. Loops are the enemies of colonoscopy. Sedation failure: Doctor or patient factors.

9. Solutions for successful colonoscopy: Tricks: New techs: New equips: Appropriate insufflations. Appropriate deflation. Delooping when occur. Deep breathing in major bends. Changing positions. Withdrawal time( > 6 mins) recording. Adenoma detection rate recording( 25% males/ 15% females > 50 years). NBI: Floresence clonoscopy. TER. Snake-like articulated computer-controlled segments. self-navigating, self-propelling device DBC. WVCE. Over tube use. Endoscopy 2008.

10. Solutions for successful colonoscopy:

12. Thank You! Dr.Mohammad Shaikhani. Assistant professor. Sulaimani Univerity. College of Medicine. Iraqi Kurdistan. [email_address]