Colonoscopy Medical Author: Eric Lee, M.D.
Medical Reviewing Author/Editor: Dennis Lee, M.D.
What is colonoscopy?
Colonoscopy is a procedure that enables an examiner (usually a gastroenterologist) to evaluate the appearance of the inside of the colon (large bowel). This is accomplished by inserting a flexible tube that is about the thickness of a finger into the anus, and then advancing it slowly, under visual control, into the rectum and through the colon. It is performed with the visual control of either looking through the instrument or with viewing a TV monitor.
Why is colonoscopy done?
This test may be done for a variety of reasons. Most often it is done to investigate the finding of blood in the stool, abdominal pain , diarrhea , a change in the bowel habits, or an abnormality found on colon x- ray or a CAT scan . Certain individuals with previous history of polyps or colon cancer and certain individuals with family history of particular malignancies or colon problems may be advised to have periodic colonoscopies because they are at a greater risk of polyps or colon cancer.
What bowel preparation is needed for colonoscopy?
If the procedure is to be complete and accurate, the colon must be completely clean. Patients are given detailed instructions about the cleansing of the colon procedure. In general this consists of a large volume of a special cleansing solution or several days of a clear liquid diet and laxatives or enemas prior to the examination. These instructions should be followed to the letter or the procedure may be unsatisfactory and have to be repeated later or a less accurate alternative chosen in its place.
What about current medications or diet before colonoscopy?
Most medications should be continued as usual, but some may interfere with the examination. It is best that the physician is informed of all current prescription or over the counter medications. Aspirin products, blood thinners ( Coumadin , etc.), arthritis medications, insulin, and iron preparations are examples of medications that may require special instructions. The physician will also want to be aware of the patient's allergies and any other major illnesses. The examiner should be alerted if, in the past, patients have required antibiotics prior to surgical or dental procedures. Instructions may also be given to avoid certain foods for a couple of days prior to the procedure, such as stringy foods, foods with seeds, or red Jello.
What to expect during colonoscopy?
Prior to the procedure an IV is started and the patient is given a monitor for continuous monitoring of the heart, blood pressure, and oxygenation of the blood. Medication is often given through the vein to make the patient sleepy and relaxed. If needed, the patient may receive additional doses during the procedure. Colonoscopy often gives a feeling of pressure, cramping, and bloating, however, with the aid of the medication it is generally well tolerated and rarely causes any significant pain.
Patients will be lying on their left side or back as the instrument is slowly advanced. Once the tip of the colon, or the last portion of the small bowel, is reached the colonoscope is slowly withdrawn and the lining is again carefully examined. The procedure usually takes 15 to 60 minutes. If the entire colon, for some reason, can not be visualized, the physician may decide to try it at a later date with a better bowel preparation or may decide to order an x-ray of the colon.
What if there are abnormalities detected during colonoscopy?
If an area needs to be better evaluated a forceps is passed through the instrument and a biopsy (a sample of the tissue) is obtained and is submitted to pathology for a microscopic exam. If infection is suspected a specimen may be obtained for culturing of any possible bacteria or viruses. If the exam is performed because of bleeding, the site can be identified, sample of tissue obtained (if indicated), and the bleeding controlled by several means. Should there be polyps (benign growths that can lead to cancer) they, almost always, can be removed through the colonoscope. Removal of these polyps is an important method of preventing colorectal cancer. None of these additional procedures typically produce pain. Biopsies are taken for many reasons and do not necessarily mean that cancer is suspected and the great majority of polyps are benign.
What to expect after a colonoscopy?
Patients will be kept in an observation area for an hour or two, until any medication given adequately wears off. If they have been given sedation before or during the procedure, someone must take them home, even if they feel alert. The patient's reflexes and judgment may be impaired for the rest of the day, making it unsafe to drive or operate any machinery. Should patients have some cramping or bloating this should be relieved quickly with the passage of gas and they should be able to eat upon the returning home. After the removal of polyps or certain manipulations, the diet or activities of patients may be restricted for a brief period of time.
Prior to the patient's departure, any findings can be explained. However, at times, a definitive diagnosis might have to wait for a microscopic analysis, which usually takes only a few days.
What are the possible complications or alternatives?
Colonoscopy complications are rare and usually minor when performed by physicians who have been specially trained and are experienced in these endoscopic procedures.
Bleeding may occur at the site of biopsy or polypectomy, is usually minor and self-limited, or can be controlled through the colonoscope. It is quite unusual to require transfusions or surgery. An even less common complication is a perforation or a tear through the bowel wall that could require surgery. Other potential complications are reaction to the sedatives used, localized irritation to the vein where medications were injected (leaving a tender lump lasting a number of days but going away eventually), or complications from heart or lung disease. Hot towels or moist packs often help relieve the discomfort of an irritated vein. The incidence of all of these, together, is less than one percent.
While these complications are rare, it is important for patients to recognize any early signs. The physician that performed the colonoscopy should be contacted if patients notice any of the following symptoms: severe abdominal pain, rectal bleeding of more than half a cup, or fever and chills.
Colonoscopy is the best test available to detect and treat abnormalities within the colon. The alternatives to colonoscopy are quite limited. Barium enema is a less accurate test performed with x-ray. It misses lesions more often than a colonoscopy, and, if an abnormality is found, a colonoscopy may still be required to biopsy or remove the abnormality. At times, an abnormality or lesion detected with a barium enema is actually stool or residual food in a poorly cleansed colon. Colonoscopy may then be necessary to clarify the issue. Flexible sigmoidoscopy is a limited examination that examines only the last third of the colon.
For further information, please visit the MedicineNet.com Barium Enema forum.
Final Word
You have been given this information so you would be knowledgeable about colonoscopy. If you have further questions about the need for the procedure, alternative methods, the cost of the procedure and whether covered by your insurance, do not hesitate to speak to your doctor or his/her staff. Most endoscopists are highly trained specialists and welcome your questions regarding their training, credentials, or any other questions you might have.
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