Nursing support plays a crucial role during colonoscopy, particularly when anatomical complexity impedes progression to the cecum (1). In our unit, four non-standardized maneuvers have proven effective in improving scope advancement during challenging cases. We aim to describe and propose these techniques as part of the nursing endoscopic toolbox.
1.“Jockey maneuver” for sigmoid reduction
When the scope tip stalls in the ascending colon and fails to reach the cecum, the nurse applies pressures from the left iliac fossa and flank area, directing the sigmoid and discendig colon toward the umbilicus. This maneuver mobilizes and straightens redundant sigmoid loops that may be stealing propulsion force or forming a hidden loop.
2. “Cyclist maneuver” – variant of the “Jockey maneuver”
When the scope tip stalls in front of the ileocecal valve and fails to reach the cecum, the nurse applies a single, pulsating pressure from the left iliac fossa and flank area toward the umbilicus. This maneuver can provide just enough additional propulsion force to reach the cecum.
3. “Jingle maneuver” – exploratory rhythmic pressure
When scope advancement is impaired and it is unclear where support is needed, the nurse applies light, rhythmic, pulsating pressure over different areas of the abdomen. This technique helps identify hidden loops and the most effective location for abdominal pressure to assist progression.
4. Lever-based maneuver for the hepatic flexure
The nurse places their hand under the right costal margin and applies a downward and medial pressure, mimicking the action of a crowbar. This creates a mechanical leverage effect, helping to straighten the hepatic flexure and facilitate forward scope movement through the ascending colon
In our preliminary observational experience, these maneuvers improved cecal intubation rates, enhanced patient comfort, and reduced the need for scope withdrawal due to looping. They are simple, reproducible, and expand the active role of trained endoscopy nurses during procedures.
These hands-on techniques may be standardized in nursing protocols and deserve further clinical validation. Their inclusion could help optimize difficult colonoscopies and enhance the technical contribution of nursing staff in the endoscopic setting.