The following ordered steps can be used to advance a colonoscope towards the caecum while using controlled fine movements of the cogs.  This algorithm can be particularly helpful when you come to a difficult bend or you start to loop and you wonder what you can do next to start making safe progress again.

1. Push colonoscope forward

2. Push colonoscope forward with clockwise torque

3. Push colonoscope forward with anti-clockwise torque

4. Pull colonoscope back with clockwise torque

5. Pull colonoscope back with anti-clockwise torque

6. MOVE PATIENT and repeat steps 1 to 5

7. Consider scope stiffener

8. Consider sigmoid pressure

9. Consider more pain relief or sedation

10. Repeat steps 1 to 10

11. Consider asking for help

12. Consider stopping the procedure