Formation of loops in the colon
A. Formation of loops in the colon can cause patient discomfort, difficulty in advancing the scope, and may increase the risk of perforation. B. Here an alpha loop has been formed in the sigmoid colon, facilitating passage into the descending colon. Clock
Minor Tip Deflection with gentle advancement
A. Minor tip deflection with gentle advancement and mild torsion allows the endoscope to traverse bends while maintaining a gentle curve. B. Sharp angulation of the tip (like a candy cane) hinders advancement and may result in paradoxical motion, where th
Dilator through the abdominal wall and into lumen
Passing one of the dilators through the abdominal wall and into the lumen of the jejunum. Care is taken to pass the dilator just into the lumen of the bowel (under visual laparoscopic control), not far enough to risk posterior intestinal wall perforation.