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Prior to insertion of the scope, a digital rectal exam is performed for the dual purpose of lubricating the anal canal as well as examining the canal for pathology and patency. The right hand is ideally double gloved so that following the rectal exam, the outer glove can be removed and discarded without the need for regloving. The scope handle is draped over the endoscopist's left shoulder or laid on the bed freeing the left hand to lift the upper gluteal fold exposing the anal canal. The anal area is visually inspected for pathology and then the rectal exam performed with the right index finger. Following the exam, the outer glove is discarded. The distal 20 cm of the scope is then liberally lubricated. The scope insertion into the rectum is then performed by one of the following manners (Figure 6.12) (Video 6.2):

Figure 6.12 Rectal intubation techniques. This illustration demonstrates the three common methods of inserting the scope through the anal canal: (a) tangential approach, (b) along‐side finger, and (c) straight insertion.

(Copyrighted and used with permission of Mayo Foundation for Medical Education and Research.)

1 Tangential approach: The scope is held in the right hand at about 10 cm with the index finger down near the tip. The scope tip is then positioned at the anal canal at roughly a 45° angle. The index finger then gently pushes the tip of the scope though the anal canal and the scope is then advanced. This technique gives better control of the tip during insertion. With this technique and the next, the second (outer) glove on the right hand remains on until after scope insertion and can then be removed and discarded.

2 Along‐side finger: The right index finger is inserted into the anal canal and the scope is inserted alongside this as the finger is withdrawn.

3 Straight insertion: The scope is held with the right hand at about 20 cm from the tip and is positioned perpendicular to the anal canal. The scope tip is then inserted straight into the rectum. This is probably the most direct approach and most commonly used method.