Colonoscopy

Colonoscopy is an imaging test performed to diagnose any abnormalities or changes in the rectum or the colon (large intestine). It is a minimally invasive procedure. Colonoscopy is done with the help of a colonoscope, which is a flexible, long tube with a tiny video camera placed at the tip of the colonoscope. The colonoscope is inserted into the patient's rectum and the doctor is able to see the in the colon and rectum very clearly. The colonoscope is very flexible in nature and can go through the entire length of the colon. It is a safe procedure that helps in diagnosing various problems at an early stage. It is possible to remove polyps or some other abnormal tissues easily with the colonoscope during the procedure, if needed. Colonoscopy is sometimes combined with biopsies, which are helpful for the doctor to take a biopsy tissue sample from the rectum or colon for further detailed analysis.


Why it’s done? What are the risks? How to prepare for the procedure? Expected results from the procedure FAQ Section

The procedure of colonoscopy is usually done to diagnose etiology and related symptoms, which are causing problems in the colon and rectum. It is also helpful in identifying the extent of various diseases present in the large intestine or colon, to confirm the findings from some previous tests like CT-scan or MRI scan. The colonoscopy is usually advised by the doctor for following reasons:

  • Screening for cancer in the colon – If the patient's age is 50 years or above, then the patient is at average risk of developing colon cancer. Colonoscopy is also generally advised by the doctor after every 10 years to get a screening for colon cancer. This procedure detects cancer growth at an early stage.
  • Investigation of any signs and symptoms in the intestine – With the help of colonoscopy the doctor can evaluate various causes for the rectal bleeding, chronic diarrhoea, chronic constipation, abdominal pains and various other problems related to the intestine.
  • Identifying more polyps – If the patient had suffered from polyps sometime back, then the doctor advises a follow-up colonoscopy, in order to locate if any more polyps have grown and to remove them during the colonoscopy procedure. Removal of the polyps is necessary because they are related to colon cancer.
  • Blood observed in the stool e.g. tarry or black stool.
  • Inflammatory bowel disease such as Crohn’s disease or ulcerative colitis. 

Colonoscopy imaging is a very effective and safe procedure if performed with expertise. There are some risks associated with the procedure, which the doctor explains before the procedure, as mentioned below.

  • Infection
  • Bleeding especially in cases where tissue sample is extracted and from where the polyps or any other abnormality is removed.
  • Perforations or tearing off in the intestinal wall (rectum or colon wall).
  • Allergic or any other adverse reactions from the sedative medication given before the colonoscopy procedure.

These risks associated with Colonoscopy can be prevented by following the instructions of the doctor carefully during the preparation process for Colonoscopy.

The doctor also asks the patient to sign a consent form before the colonoscopy procedure in order to authorize it from the patient.

The doctor will discuss the Colonoscopy procedure with the patient in detail, along with its benefits and risks.

Before the procedure:

Some points to be taken into consideration are as follows:

  • The doctor takes a complete medical history and physical examination test before performing the Colonoscopy procedure. The patient may be asked about age of the patient, any past surgeries, allergies to any medicines, previous personal history and family history of abdominal or gastrointestinal problems (colorectal cancers). In the physical examination, the doctor examines the patient very carefully for any other concerning signs and symptoms.
  • The doctor also advises to bring along the previous test report before the procedure i.e. any blood investigations, X-ray, CT-scan or MRI scan.
  • The patient is advised to avoid the blood-thinning medications before the colonoscopy scan such as ibuprofen, aspirin and so on. The use of such medicines may lead to excessive and uncontrolled bleeding, especially if the procedure is combined with biopsy. Hence, it is important to take the medicines as and when prescribed by the doctor.
  • In case a patient is diabetic, it is important to ask the doctor to take insulin before the procedure or not.
  • Inform the doctor about any past allergies or surgeries, if any.
  • Avoid drinking or eating anything solid at least a day before the colonoscopy procedure. The patient is usually advised to consume clear liquids tea and coffee without cream and milk, water, broth, and carbonated drinks. The patient is asked to avoid red colored drinks which may be mistaken for blood during the procedure. The doctor usually advises not to consume anything one night before the procedure day until the colonoscopy is finished.
  • The patient is advised to empty the urinary bladder and bowel, before the procedure. The patient is advised to take some laxatives or an enema, or sometimes to follow a liquid diet before the colonoscopy procedure.
  • The doctor advises to either take laxatives only at night or both at night and morning of the procedure. It can be taken in any form liquid or a pill.
  • Change into a hospital gown.
  • This procedure does not need any hospitalization and the patient can go back home after the procedure.
  • The doctor advises the patient to bring a companion along to drive back home safely.

 

During the procedure:

  • The doctor gives sedative medicines to make the patient relax and calm down.
  • The patient lies on the examination table on the side and is advised to fold the knees close to the chest.
  • Then the doctor passes a colonoscope (a small tube-like structure, flexible in nature with a light fitted in it) through the patient’s rectum.
  • The colonoscope goes through the entire length of the colon due to its flexibility. It also consists of a light and a tube with the help of which the doctor pumps air into the colon to inflate it. This inflation of the colon helps the doctor to get a better view of the inner colon lining.
  • Sometimes, when the doctor pumps air into the patient's colon, the patient might feel a slight abdominal cramp or a bowel movement urge.
  • The colonoscope is also fitted with a video camera that sends images on the screen outside the patient's body.
  • The doctor can also insert some small instruments through the channel for the biopsy tissue sample or to remove the polyps or any other abnormal tissue.
  • Then the colonoscope is carefully removed from the patient’s rectum.
  • The procedure of colonoscopy takes around 20 minutes to 60 minutes to complete.

After the procedure:

  • After the procedure, sometimes the effect of sedatives takes an hour to fade off completely.
  • The patient is advised to bring a companion along to take care of the patient and drive back home safely until the sedative effect fades away.
  • The patient is also advised by the doctor not to return back to work or drive the same day after the procedure.
  • If the doctor removed some polyps during the procedure, then the patient has to take a strict diet for some days.
  • The patient might have a bloating feeling and may pass gas for quite some time. This is due to the air filled by the doctor during the colonoscopy. However, this problem can be relieved by walking.
  • Some patients might observe some blood with the first stool they pass after the colonoscopy.

The doctor must be immediately called if the patient observes any of the following problems after going home:

  • Continuous passing of blood with the stool every time.
  • Chronic and persistent pain in the abdomen.
  • Fever 100 F or 37.8°C or more than this.
  • Burning sensations
  • Swelling
  • Abdominal distension

The doctor will discuss the procedure report in detail with the patient.

  • Negative – This means that the report results are negative, i.e. there are no signs of any abnormality in the patient’s colon or rectum. If the patient is of 50 years (age at which the risk of colorectal cancer is high) and there are no signs of colorectal cancer growth, the doctor advises screening after every 10 years for colon cancer by colonoscopy. This detects cancerous growth at an early stage. Sometimes, if there is any residue, then the doctor may ask the patient to repeat the procedure again.
  • Positive – The colonoscopy results are positive if the doctor detects any presence of polyps or any other intestinal abnormalities. Usually, the polyps are non-cancerous however, some are pre-cancerous in nature. These polyps when removed are further sent to the lab to test for the cancerous or non-cancerous nature. If the size of the polyps is big, then the patient is advised to follow a rigorous and strict screening schedule
  • Sometimes, if the images are not clear after the colonoscopy, then the doctor might recommend another colonoscopy.
  • If the doctor had some problem while passing the colonoscope through the entire colon, then virtual colonoscopy or barium enema is advised in order to examine the rest of the portion of the colon.

Q1. How often the doctor advises to get a colonoscopy done?

A1. If the doctor detects one or two polyps of less than 1 cm or 0.4 inches in diameter, then another colonoscopy is recommended in at least 5 to 10 years. It also depends upon other related risk factors for developing colon cancer.

If the size of the polyps is large, or the polyps observed are more in number or with some specific cell characteristics, then the patient is advised to get another colonoscopy procedure in 3 to 5 years. It also depends upon other related risk factors for developing colon cancer.

If the doctor removes one or more polyps of cancerous type, then the procedure is advised in 3 months, 6 months or every year. If the polyps, which are cancerous in nature, are not removed during the procedure of colonoscopy, then the doctor recommends surgical removal of polyps.

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