Colonoscopy is a complete examination of the large intestine (Colon). A flexible lighted tube fitted with a tiny camera is inserted through the anus. The inside of rectum and colon can be viewed for polyps, cancer, or diseases such as ulcerative colitis or Crohn’s disease. Tissue and polyps can be removed during the procedure.
Reasons for a Colonoscopy
Screening Colonoscopy
A screening Colonoscopy is done to check for cancer and inflammatory diseases like ulcerative colitis. Most colorectal cancers (CRC) start as non-cancerous polyps(tiny, fast growing cells that may become cancer). Removing polyps or finding cancer at an early stage can increase your chances for a full recovery. During the Colonoscopy, polyps can be removed with tiny instruments such as snares of forceps.
*The risk of developing CRC is increased if you have ulcerative colitis or Crohn’s disease or have a parent or sibling who had CRC before age 60.
Diagnostic Colonoscopy
A diagnostic colonoscopy is done to check for certain medical conditions such anemia, a change in bowel habits, or abdominal pain.
Therapeutic Colonoscopy
A therapeutic colonoscopy can treat a known problem inside the colon such as bleeding or narrowing.
*For bleeding, your doctor may seal off the bleeding location by injecting medication, heat treatment or clipping the bleeding site.
*Strictures (narrowing or partial blockage of colon) can be widened by inserting a balloon through the endoscope and inflating it inside the colon. A small stent (tube) may be left in the narrowed area to keep it open.
Surveillance Colonoscopy
A surveillance colonoscopy is a follow up for patients with a history of colon polyps, cancer, or inflammatory bowel disease.
Colonoscopy Benefits and Risks
Benefits – A colonoscopy is the most accurate way to find and remove small polyps. Removing polyps at an early stage can decrease your risk of death from colon and rectal cancer.
THE RISK
Perforation of the intestine
WHAT HAPPENS
A hole made by pressure from the scope that passes through the entire wall of the colon is a rare complication reported in less than 1 of 1,000 cases.
A large perforation noticed immediately requires surgery. A small perforation noticed the first few days after the procedure may be treated with rest, fluids, antibiotics, and close observation.
THE RISK
Bleeding
Bleeding is reported in 0 to 6 of 1,000 procedure. The risk is increased when many or a large polyp is removed.
A small amount of bleeding may occur after colonoscopy. Call your doctor if you notice more than four tablespoons of blood (one shot glass) with bowel movements within the first two weeks of your colonoscopy.
THE RISK
Cardiorespiratory
Minor changes in oxygen levels and heart rate occur in less than 1 of 1,000 cases.
The majority of these events are related to sedation and increase with advanced age and other disease.
THE RISK
All complications
33% of patients report at least one minor symptom after colonoscopy but serious complications are uncommon.
Checking for any problems with medication and sedation and monitoring before during and after the procedure will reduce risks.
Expectations: Preparing for Colonoscopy
The Procedure and Recovery
Sedation
You will be placed on your side usually with your knees drawn toward your chest. You will be given medication usually though an IV line to help you relax and remain comfortable. You many or may not fall completely asleep during the procedure, but most patients will not remember their colonoscopy. Talk to your doctor about the type of sedation and side effects. Common drugs are benzodiazepines (midazolam). Opiods (Fentanyl) and other agents ) like Propofol.
The Procedure
Your doctor will guide a scope that is inserted into the anus and passed up to the colon. Small amounts of air are inserted to open the colon and allow viewing of the surrounding area. The tube has a light and camera at the end and sends a picture to a TV screen.
Your heart rate, breathing, and oxygen level will be monitored during the exam. The procedure will take about 15 to 60 minutes. If your doctor sees abnormal tissue or polyps, they will be removed or biopsied.
Your Recovery
You will receive sedation or relaxation medication, you may feel groggy and you should not make any big decisions, drive or return to work for the rest of the day.
Diet
You may be eager to eat a large meal after fasting, but it is a good idea to start with light meals and ease into solid food for the first day.
Pain
Severe pain is rare after the procedure. You may have minor cramping and gas after you pass gas, the cramping should be gone.
Bowel Movements
You should return to your normal bowel pattern within 2 to 3 days after your procedure.
If you had a biopsy or polyps removed your doctor will let you know:
*When and how you will be informed about your results.
*If you need to avoid aspirin on ibuprofen after the procedure.
When to Contact your Gastroenterologist:
Call your doctor if you have:
*Severe abdominal pain or if your abdomen feels hard, this could be a symptom of colon perforation.
*bleeding for more than 2 bowel movements or bright red bleeding that fills a short glass.
*Fever greater than 100.4°F or 38°C.
*Swelling redness, or changes at the IV site.
*Weakness, shortness of breath or fainting.
*Nausea or vomiting blood.