A colonoscopy is a screening examination to evaluate abnormalities or growths in the colon (large intestine) and rectum. This test is considered a crucial procedure since colorectal cancer is the second leading cause of cancer-related deaths in the United States.
According to the Journal of Clinical Oncology (June11, 2012), people undergoing a colonoscopy had a 65% lower risk of colon cancer death than those without screening, which emphasizes the need for this procedure.
A colonoscope (long, flexible tube with light and camera attachments) is inserted into the rectum and advanced with air until the complete colon inner lining is visualized. Any polyps or abnormal areas are removed during the procedure. Biopsies and polyps are sent for pathological evaluation.
Doctors Who Perform Colonoscopy
Throughout your care for colonoscopy, you may encounter the following team of doctors, specialists, and other health professionals:
Gastroenterologist – a physician who specializes in the health and conditions of the digestive system and digestive organs. In some places, when one is not available, a general surgeon performs that function.
Anesthesiologist – a doctor who administers sedation for the procedure.
How to Prepare for Your Colonoscopy
Preparation for a colonoscopy should start at least one week prior to the procedure.
The first step is to discuss:
- All questions and concerns you have
- Medical history
- Allergy history – Latex or sedative allergies should be known prior to the procedure so precautions may be taken.
- Medications – Aspirin and other drugs that affect coagulation of blood (e.g. Coumadin, warfarin, Plavix) need to be discontinued until after surgery; drugs treating diabetes, hypertension or cardiac problems may need to be regulated with different doses prior to the procedure.
- Diet-only clear liquids, which can be taken for 24 hours prior to surgery.
- Ingredients in liquids to be avoided:
- Red dye
- Bowel prep – Many physicians have a specific protocol of laxatives in pill or liquid form which may start the day or night prior. Some may also advise an enema to ensure an empty bowel prior to the procedure.
Questions to Ask Your Doctor About Colonoscopy
From your initial diagnosis throughout your treatment and care, you will have questions about your colonoscopy. Below is a list of questions to discuss with your doctor so you can make informed decisions about your condition and your care.
Questions About My Diagnosis
- Do you measure your adenoma detection rate? What is it?
- If polyps are removed, are they sent to a laboratory for diagnosis?
- How long would it take for lab results?
- Is an anesthesiologist used for sedation?
Questions About My Treatment
- What type of bowel prep will I need? Why is this one chosen?
- What side effects can I expect from the procedure?
- What risks are associated with the procedure?
- What symptoms would be abnormal?
- What symptoms indicate emergency care is needed?
- Will surgical removal be done during the procedure if polyps or abnormal growths are seen?
- Is laser treatment available with this colonoscopy?
- Can I get a copy of pictures or video taken?
Questions About My Lifestyle & Family
- When do I need to stop eating and start a clear liquid diet?
- When can I resume eating?
- Do I need to stop certain medications? If so, when?
- Do I need to take antibiotics before the procedure? If so, when?
- When can I return to work?
- When can I resume sexual relations?
- When will my follow-up evaluation be?
- How often must I have this procedure done?
What To Expect
After checking into the reception desk, you will be escorted to a prep room where you will remove your clothes and put on a hospital gown.
The nurse will discuss your history of:
• Medical conditions
• Proper preoperative preparations
The blood pressure cuff will be applied. The pulse oximeter will be placed over your index finger to measure oxygen saturation and heart rate values.
The anesthesiologist will then enter the private cubical/room and review the history (as above). Further, the anesthesiologist will discuss with you the type of sedation that you will receive, making sure that you have not had a reaction to this before, and explaining what reactions you can expect.
Your physician will enter the room, review any instructions and discuss any concerns you have. Now you are ready for the procedure.
You are brought to a sterile room where you will be asked to position yourself on your left side on the exam table. Anesthesia is administered.
The physician will insert a flexible scope with lighting and camera attachments into your rectum and advance upward through the colon to carefully examine it. Biopsies of growths will be taken and any polyps found will be removed. Bleeding points are cauterized as encountered.
When the doctor is satisfied that the colon is completely examined, the scope is removed and you are brought to the recovery room for postoperative care and monitoring. The sedation takes approximately 30 minutes to dissipate. Once awake, you may be offered water to drink and the examining doctor will return to discuss his/her findings and his recommendations.
When you are alert and have stable vital signs, you will be asked to discard the hospital gown and put on your regular clothes. The nurse will review the discharge instructions and give any prescriptions to you from the doctor. You will then be brought out to your waiting transportation and allowed to go.
Since a colonoscopy is a surgical procedure, certain symptoms can be expected, including:
- Fatigue or wooziness – Dizziness or lack of alertness stem from the anesthesia used in the procedure. Symptoms will improve as the drug effects diminish. Until then, one should not return to work, operate heavy machinery or drive. Make plans for transportation home from the procedure ahead of time.
- Bloating or cramping – Inflation of the bowel with air may cause cramping or discomfort which lessens over the course of the day as the air is absorbed.
- Slight bleeding – Trace staining or spotting may occur due to irritation of the intestinal lining. If bleeding is significant, however, one should contact the surgeon immediately.
- Activity – Rest after the surgery for the balance of the day.
- Diet – A normal diet, as tolerated, can resume as soon as desired.
Post-op appointments are generally made for one to two weeks after, especially if biopsies were performed with the colonoscopy, though initial results are given before discharge from the facility.
Symptoms of a colonoscopy are typically gone within 24 hours but may last up to 48 hours.
Common Tests or Labs Done in Conjunction with Colonoscopy
Tests that are done in conjunction with colonoscopy include:
|Test||Why Test?||What Happens?||Normal Result|
|Culture of side walls||H.Pylori cultured to determine if intestinal lining is irritated or ulcerated secondary to infection||Fluid is removed through aspiration with suction through a channel in the endoscope and sent for analysis.||Negative culture|
|Biopsies||Sampling of abnormal tissue||A biopsy forceps is passed through a channel in the endoscope and a snippet of abnormal tissue or growth is taken. Bleeding points are cauterized.||No malignancy or abnormal cells on slide|
Common Treatments Related to Colonoscopy
While endoscopy is a screening procedure, there are treatments for the digestive tract performed through the endoscope (colonoscope) during the actual surgery.
|Treatment||How it works|
|Polypectomy||A thin wire snare is inserted through a channel in the endoscope and lassoed. Electrocautery is applied at the base to remove the polyp and cauterize any bleeding points.
The polyp is then sent for analysis.
|Laser therapy||Laser is passed through the channel to create a passageway in obstructed bowel to assist in stent placement. Laser is also used to blast a lesion rather than surgically removing it.|
|Self-expanding metal stents (SEMS) insertion||Stents are inserted to decompress the bowel obstructed from tumors and growths. This is an alternative option to surgery, radiation, and chemotherapy, as well as preoperative bowel prep for resection of masses.|