Colonoscopy

General Information

Colonoscopy is an endoscopic procedure that visually examines the entire colon. The preparation is with an oral solution that removes the waste from the colon. The inside of the colon is then examined for any abnormalities that may exist. During this procedure, polyps may be safely removed. This procedure is commonly performed for evaluation of abnormal radiographic studies, removal of polyps, assessment of bleeding and screening for colon cancer.

Indications

Colonsocopy is indicated for patients with inflammatory bowel disease, GI hemorrhage, polyp removal, screening for colon cancer and evaluation of abnormal x-rays of the GI tract.

Other Methods of Evaluation

An alternative exam to assess the colon is the barium enema. CT scans of the abdomen and pelvis are useful but do not always provide sufficient information about the colon itself. CT scans are not a good test for looking at tubular structures. They are, however, excellent tests for looking at structures surrounding the colon and intestines.

Before the Procedure (Preparation)

An oral laxative solution is given the day before the procedure. This will cleanse the waste from the colon. It is important that the preparation be followed completely. This procedure examines the inside of the colon. Thus, if feces are retained, or the preparation is inadequate, areas of the colon that may be of importance to your health may be missed or misinterpreted. Usually the preparations given for these are excellent. If you have specific difficulties with laxatives or the preparations, please inform your physician beforehand so that alternatives can be addressed.

Please make sure that your physician knows well beforehand if you are taking any blood thinners. Specific instructions regarding the preparation are available in the section regarding preparations for procedures.

Risks of the Procedure:

Colonsocopy is a safe and highly effective technique. In experienced hands, this procedure has the following risks:

Bleeding
Allergic reaction to a medication
Perforation of the Colon

Bleeding can occur up to 10 days after the procedure. The chance of bleeding will increase depending upon the number, location and size of polyps (if any) which are removed. Some patients have bleeding from hemorrhoids after the procedure.

An allergic reaction to a medication can occur. This is usually identified early since blood pressure, heart rate, oxygen saturation and general clinical condition are monitored during the entire procedure.

Perforation of the colon occurs when a hole is put through the colon. This can be associated with removal of polyps or simply passing the endoscope through the colon. This complication will usually result in a patient being treated in the operating room.

When all patients are included and all of the above are also included, the chance that one of the above complications will occur is about 1/1,000 cases.

Overall, colonoscopy is a well tolerated procedure that has many benefits and few complications when done for appropriate reasons by an experienced gastroenterologist.

The Procedure

In general, this procedure takes approximately 30 to 45 minutes to perform when done by a trained gastroenterologist. The procedure may take longer depending upon the intervention that may be required for any individual patient.

During the procedure, a fiber optic endoscope will be inserted into the anus. The scope will then be advance through the inside of the colon to the cecum (last part of the colon). Inspection, removal of polyps, etc. usually occur during withdrawal of the endoscope.

Patients undergoing this procedure usually receive a combination of intravenous anesthetics. These are usually Demerol (meperidine), Versed (midazolam) or Fentanyl. The exact combination, dose and frequency of each of these are individualized for each patient. In most cases, patients do not remember their procedure or are adequately sedated such that the discomfort is well tolerated.

During the procedure, the nurse assisting your physician with the procedure will continuously monitor your heart rate, oxygen saturation and blood pressure. Thus, should any difficulties occur, your physician and his team will be aware of the change quickly.