How to achieve cecal intubation in patients with angulated and redundant colons?

Colonoscopy has many purposes, both diagnostic and therapeutic. Accepted standards indicate that the cecum should be reached in 95% of screening examinations and 90% of all procedures. Some patients may have difficult or elongated colons, which may make successful intubation more difficult. This article reviews some common strategies for achieving cecal intubation in these colons. It includes a series of rules developed and used for trainees and expert endoscopists alike to safely complete a colonoscopy with a high degree of reliability. It also includes a review of common strategies, techniques, and tools that can be used to increase success rates.