What should be done to maximize the success of passing the ascending colon during endoscopy?

To maximize the success of passing the ascending colon during endoscopy, applying pressure to the transverse colon and positioning the patient to the right can facilitate the maneuvering of the endoscope. This technique capitalizes on the anatomy and natural curvature of the colon. By applying pressure to the transverse colon, it can help to create a more favorable angle that allows the scope to traverse the bend more easily. Additionally, rightward rotation of the patient aligns the colon's curves with the trajectory of the endoscope, reducing resistance and increasing the likelihood of successful passage.

In the context of other strategies, using counter-clockwise torque may not accommodate the anatomical layout effectively as it could lead to additional resistance in navigating the bends of the colon. Advancing the endoscope with the tip downwards could hinder passage, as it may not follow the natural curvature of the colon appropriately. Expansion of the colon with gas insufflation is beneficial but is a supportive measure rather than a direct maneuver for navigating the ascending colon. It primarily serves to distend the colon for improved visibility and access rather than as a method for facilitating passage through the anatomical turns. Thus, strategically combining pressure application and patient positioning is the optimal approach for successful navigation in this scenario.