Key Concepts

• Endoscopic examination is essential in the evaluation of patients with colorectal complaints and is a key component of a complete colorectal examination.
• Physical examination, anoscopy, rigid proctoscopy, and flexible sigmoidoscopy are components of the exam that can easily be performed in the office setting to evaluate complaints arising from the anus, rectum, and rectosigmoid colon.
• Colonoscopy allows for complete evaluation of the entire colon and rectum, as well as the terminal ileum.
• Multiple regimens for bowel preparation prior to colonoscopy exist, and the endoscopist should be aware of the differences. A split-dose prep has been shown to be more effective than a single-dose prep.
• The endoscopist should be familiar with sedation regimens for endoscopy, including possible adverse effects.
• A number of adjunctive maneuvers for difficult exams and alternative techniques to improve the quality of endoscopy can be employed.
• The endoscopist should be able to recognize and manage complications of endoscopic procedures and employ appropriate measures to prevent their occurrence.
• Quality measures to ensure adequacy of colonoscopic examinations include adenoma detection rate and withdrawal time.