Before the Procedure
There is quite a bit that needs to be done prior to beginning a colonoscopy procedure, such as evaluating the patients’ bleeding risk as well as performing a basic physical examination. It is also crucial to obtain the patient’s informed consent after providing them with a thorough explanation of the procedure and all of the risks associated with it.
It is important for those who are going to undergo a colonoscopy to inform their doctor of any medications they are taking, as well as any allergy to medications. A doctor may request that the patient stop taking aspirin products or certain supplements 1 to 2 weeks before the procedure. Those who are scheduled to undergo a colonoscopy must refrain from eating solid foods and drink clear liquids only 1-2 days prior to the procedure.
Before the procedure is even scheduled, the doctor will sit down with the patient to discuss a number of things, including the potential benefits as well as risks, alternatives, and what exactly will happen if and when the colonoscopy is performed. The doctor will also discuss the nature of the procedure so that the patient has a firm understanding of what it is all about.
During the Procedure
A colonoscopy can be performed in a number of settings, including a clinic, doctor’s office, or hospital. This particular procedure is usually performed by a doctor who specializes in gastrointestinal issues, though they may use an assistant to help them with anything they may need. There are also a number of surgeons and family doctors as well as internists who have received adequate training to perform this procedure.
Pain medication or a sedative is typically given to the patient intravenously with an IV in the arm. The medicine that the patient receives helps them to relax and fall completely asleep until the test is done. Before the procedure, the patient must remove all of their clothes and put on the gown they are given to wear for the duration of the colonoscopy. Some doctors instruct their patients to lie on their left side with their knees tucked into their stomach. It is unlikely that any patient who is properly sedated for this procedure will remember much if anything at all.
Once the patient has been sedated and is no longer fully conscious, the doctor inserts a thin, flexible tube called a colonoscope into the patient’s anus, slowly moving through the recum and into the large intestine (colon). Air is used as a means of inflating the colon so as to provide the doctor performing the procedure with a better look at the lining. Sometimes the doctor will look at the lining of the colon using the scope or a computer screen that is connected to the scope.
Many patients feel like they need to have a bowel movement while the scope is inside them, which is completely normal. It is also considered normal to feel a cramping sensation, which can be reduced by simply breathing deeply and slowly through the mouth. Many patients who undergo this procedure also feel air escaping around where the scope was inserted. The doctor will look at the entire length of the colon while slowly guiding the scope in and out of the colon.
Sometimes doctors use small tools like forceps or swabs to collect tissue samples so they can closely examine them later on. Any significant growths that are found during this procedure are typically partially removed or biopsied to check for cancer. It is not common for people who undergo a colonoscopy to feel anything, even if polyps are removed.
After the Procedure
Patients who undergo a colonoscopy are typically asked to stay for 1 to 2 hours before going home. The doctor who performs the procedure will put together all of the required documentation, including written documents as well as photographs that were taken during the procedure. Any tissue samples that were taken during the colonoscopy will be thoroughly documented and later tested. Results from any tests performed on biopsied tissue samples are discussed with the patient. A system must also be in place for the purpose of tracking post-operation complications that may arise.
Purposes of a Colonoscopy
A colonoscopy can be recommended for a patient for a number of reasons. This procedure has diagnostic and treatment benefits for many people. Some of the more common reasons for a colonoscopy to be scheduled include:
- Screening for cancer: A doctor may suggest a colonoscopy for a patient to check for signs of cancer in the large intestine. Sometimes this is done simply because of the patient’s age, while other times it is because the patient may exhibit certain symptoms that may be indicative of colon cancer or another problem relating to this area. The patient’s family history and personal medical history will ultimately determine when this type of screening will begin. If a polyp or some other anomaly is found during the procedure, it is removed with the use of an endoscope if possible.
- Lower gastrointestinal bleeding: A colonoscopy may be performed if a patient has or recently experienced hematochezia or stool in the blood. Both of these are good enough reasons to perform this procedure, as it can be effective in identifying the cause. If the source of the bleed is identified, the patient may have to undergo endoscopic therapy.
- Lower gastrointestinal symptoms: Certain lower gastrointestinal symptoms, such as chronic diarrhea with no clear explanation, may warrant a colonoscopy. This procedure is not typically done to find the case of chronic constipation unless there are obvious warning signs. Sometimes a colonoscopy is performed to find the source of chronic abdominal pain, though it depends on the age of the patient among other risk factors that are taken into consideration.
- Abnormal imaging: This procedure can also be quite effective when it comes to getting a better look at anomalous images detected during a CT scan, barium enema, or some other procedure. Some of the different anomalies that may require a colonoscopy include filling defects, mass lesions, and strictures. A colonoscopy may also be performed on a patient if a polyp is detected during a radiographic procedure, depending on the size of the polyp.
Equipment that is used
A colonoscopy is performed with a standard high-definition, white-light (sometimes blue if using Olympus) colonoscope. This tool is essentially a thin, long tube that provides the doctor who is performing the procedure with a close look at the walls of the patient’s large intestine. The same type of colonoscope is used for both pediatric and adult procedures, though there is a slight size difference. While a regular adult colonoscope is 13mm in diameter, a pediatric version is only 11mm. This tube becomes increasingly flexible the smaller the diameter it is, allowing the doctor to navigate through the large intestine with ease.
While it is true that a colonoscopy is a relatively safe procedure that has become extremely common, there are still certain risks associated with it, including:
- Postpolypectomy Syndrome: This particular complication can come about as a direct result of electrocoagulation injury to the bowel wall, which in turn leads to a transmural burn. Some of the more common symptoms of this complication include fever, focal abdominal tenderness, and leukocytosis for 1-5 days after polypectomy.
- Infection: While infection is not incredibly common when performing a colonoscopy (provided it is performed in a sterile setting), it is still a possibility. There have been previous cases of transmission of hepatitis B and C as well as various kinds of bacteria as a result of medical staff breaking established protocol.
- Gas explosion: It is true that gas explosion is a very uncommon complication, but it is still possible. Gas explosion occurs because of hydrogen gas in the colonic lumen from electrosurgical energy. This complication can sometimes happen if plasma coagulation is used to control the patient’s bleeding.
- Bleeding: Bleeding is not very common at all when it comes to colonoscopies, though it can happen with polypectomy. There are a number of things that can be done to manage this complication so that it does not become a serious risk to the patient’s overall health and well-being.
- Sedation complications: It is incredibly important that proper anesthesia risk assessment of the patient is performed prior to beginning the procedure to reduce the risk of any sedation-related complications. It is also crucial that the patient’s anesthesia level is monitored closely before, during, and after the procedure to ensure that there are no problems.