In order to perform advanced techniques of colorectal endoscopic therapy with ESD, it is essential to perform a quality colonoscopy that allows access to the lesion. Below are the key points that will be visually reflected in the youtube links that appear at the end of the entry:

1. Perform the colonoscopy with the lowest insufflation possible, rectifying from the first angulation found.
2. Maintain control of the colonoscope at all times, inserting it with the right hand and performing the movements of the U/D and R/L controls «exclusively with the fingers of the left hand».
3. Left-right rotational movements with the left wrist help to perform fine lateral movements of the endoscope tip (very important in ESD)
4. The most common loops are those located in the sigma (alpha loop) and transverse colon (omega loop). You have to try to avoid them and rectify as many times as necessary.
5. Sometimes, in order to advance the colonoscope, it is necessary to press lightly in the areas where the loops occur (FII and suprapubic region for the «alpha-loop», as well as left hypochondrium and epigastrium for the «omega-loop».
6. The cecum must be reached with no more than 70-80 cm.

Utilization of left hand to facilitate precise endoscopic control during colorectal ESD

Basic Techniques of Colonoscope Insertion