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COLONOSCOPY
By gi health
Tremendous progress in the field of fiberoptics has made it relatively simple for your doctor
to examine the entire large intestine, or colon, with a procedure called colonoscopy. More
accurate than a barium enema x-ray and much simpler than exploratory surgery,
colonoscopy is a safe and highly effective diagnostic technique.
After careful assessment, your doctor has decided that a colonoscopy is necessary to better
evaluate and treat your condition. Since your cooperation is essential for a successful
examination, it is important that you understand exactly what is to be done and why. If you
have any additional questions or concerns after reading this article, please ask your doctor.
What Is Colonoscopy?
Colonoscopy is a medical term that has two parts - colono which refers to the colon, or large
intestine, and scopy which means "looking into." Therefore, colonoscopy is a test that
enables your doctor to look inside your colon. The instrument used to perform this test is
the colonoscope: a long, flexible tube about the width of your index finger. Within the end
of this tube is a miniaturized color-TV camera with a wide-angle lens. After passing this
"scope" through the rectum and into your colon, your doctor then directly examines the
lining of your lower digestive tract on a television monitor. In this manner, it is possible to
evaluate intestinal inflammation, ulceration, bleeding, diverticulitis, colitis, colon polyps,
tumors, etc.
As part of your assessment, you may have undergone a barium enema examination of the
colon, or "lower GI series." This technique, which utilizes x-rays, is helpful in identifying any
areas of possible abnormality. X-rays are only shadows, however, and often do not fully
demonstrate what is wrong. For example, the barium enema x-ray may miss nearly forty
percent of colon polyps.
In the past, you also may have undergone a proctoscopic examination of the lower colon
and rectum. Performed with a short, rigid, hollow tube, this limited procedure enabled the
doctor to examine only the last ten inches of the large intestine. In most offices, the
proctoscope has now been replaced by the flexible sigmoidoscope. This newer device
enables your doctor to examine the last two feet of the colon while its flexibility affords the
patient much greater comfort than does the rigid type of scope.
The colonoscope offers a still greater advantage. With this longer flexible instrument, your
doctor is usually able to directly examine the entire length of your colon - all five feet of its
numerous twists and turns. In this manner, your doctor can be most certain about the
condition of your colon.
How You Can Help
Your cooperation is essential for a successful examination. There are certain things you can
do to help before the test begins:
Preparation
A colonoscopy exam requires a thorough cleansing of the large intestine so that nothing
impedes your doctor's view. The colon must be completely free of all solid waste. Since
particles of stool can interfere with the examination, you will require a special dietary and
laxative preparation on the day prior to the test. To be sure that you fully understand all
aspects of the preparation, the GI Assistant or a member of the Nursing staff will review the
preparation with you. It is critical that you follow the instructions as given. If the colon is
not clean, the test - as well as the preparation - may have to be rescheduled. A few hints: It
is best not to be constipated before the laxative preparation. This may lead to a temporary
backup of the laxative solution, cramps, bloating, nausea, and vomiting. If you tend to be
constipated, take one or two ounces of Milk of Magnesia the day before the laxative prep to
"open up your pipes." This will make the actual preparation easier. If you develop mild
distress during your prep, simply stop it for an hour or two and then resume it where you
left off. If you develop severe abdominal cramps or persistent nausea and vomiting, stop
the prep and call our office to reach our doctor on call. Of course, the laxative preparation
will cause you to have many bowel movements. This may cause some rectal irritation and a
small amount of bleeding. Many patients find that using Charmin Plus toilet tissue minimizes
such rectal irritation. A nonprescription 1% hydrocortisone cream may also be soothing
when applied to the rectal area after each bowel movement. Please avoid foods with many
small seeds for a few days before the exam. They tend to linger in the colon and can clog
our instruments. In addition, you must avoid all red-colored Jello products during your
preparation as their red dye masks the lining of the colon.
Medications
Medications containing iron or Metamucil-like fiber can impair your doctor's view of the
colon. If possible, they should be temporarily discontinued several days before the test. If
you are taking chronic aspirin or Persantine therapy, diabetic medication, or the bloodthinner Coumadin, you will require special preparation and adjustment of your medicines
before the test. Please call our office for instructions. All other routine medications may
continue to be taken with a small sip of water, even on the day of the exam.
What To Wear
You will have to change into a patient gown before the examination. If this test is being
done on an outpatient basis, you should wear, loose, comfortable, casual clothing that is
easily removed and folded. Avoid girdles, pantyhose, or tight-fitting garments. Please leave
your jewlery, valuables, and high heels at home. Transportation To minimize any
discomfort, you will receive an injection before the colonoscopy. As this medication will
make you drowsy for several hours, you cannot safely drive a car for the remainder of the
day. Therefore, if this test is being done on an outpatient basis, a family member or friend
must accompany you to the office in order to drive you home. If possible, you should
choose someone with whom the doctor can freely discuss the results of your test. We
request that your companion remain in the office during the test. You should arrive several
minutes before your appointment and plan to stay approximately two hours.
If the test is being done on an inpatient basis, a driver will not be needed. After the test,
you will simply return to your hospital room to sleep off the remainder of the medication.
You will be asked to remain in bed several hours to allow the sedation to wear off
completely.
Your Permission
If you have any questions or concerns about this test, do not hesitate to ask your doctor
about them. To signify that you completely understand what this test involves, you will be
asked to sign a written consent form, or "permit," before the test begins.
Looking Inside
Prior to the test, you will be asked to remove your clothing and to slip into a patient gown.
After signing the permission form, you will be positioned comfortably on your left side on
the padded colonoscopy table. A small painless oximeter probe will be placed on your
fingertip to monitor your pulse rate and breathing function during the exam. A thin nasal
oxygen tube may be used to administer low flow oxygen during the exam. Then you will be
given an intravenous injection of Demerol (pain killer) and Versed (tranquilizer); these
medications will make you drowsy and relaxed, thus minimizing any discomfort during the
examination. Please inform the doctor if you are allergic to Demerol or Versed, or if you
chronically take narcotic painkillers such as Percodan, Percocet or Codeine, so that other
medications can be substituted. Furthermore, rest assured that these medications will not
prompt you to act or speak foolishly during the test.
Your doctor will then examine and lubricate the rectal opening to allow simple passage of
the colonoscope. This will not be painful, but is mildly uncomfortable for a few seconds.
After the colonoscope is properly positioned, your doctor gently guides the scope through
the colon, a process that takes approximately one-half hour. To improve visualization, your
doctor gently infuses air into the colon. This may cause a sensation of abdominal fullness,
but should not be painful. In fact, many patients actually fall asleep during the examination.
As the test progresses, you may be asked to change your position now and then to facilitate
the passage of the colonoscope through the colon. Here is a xray of the abdomen taken
during a colonscopy which demonstrates how far the scope travels into the colon all the way
to the right side of the colon.
Occasionally, passage of the colonoscope through the entire colon is impossible. While this
may be caused by a blockage, it is most often caused by an extra "loop" of colon, adhesions
from previous abdominal surgery, or severe diverticulosis. In such cases, a limited
examination may be sufficient if the area of suspected abnormality has been visualized. If
not, a barium enema x-ray (lower GI) may also be necessary.
Taking Specimens
If colonoscopy reveals any unusual condition such as inflammation, an ulcer, a tumor, or a
polyp, your doctor may photograph it. This photo provides a permanent record for your
medical chart and allows your other doctors to see what is wrong. With the advent of videocolonoscopy, it is now also possible to record the examination on a videocassette for later
review when necessary. To better evaluate any areas of suspected abnormality, your doctor
may take a brushing or biopsy of the colon lining. A brushing involves the passage of a tiny
nylon brush through the center of the colonoscope. The brush rubs against the lining of the
colon and retrieves bits of tissue for later analysis. To take a biopsy, the doctor passes a
metal forceps through the scope and snips off a tiny sample of colon tissue for laboratory
analysis. Both procedures are totally painless for the patient. Be assured that the decision to
take a biopsy does not necessarily mean that your doctor suspects cancer. Biopsies of the
digestive tract are often taken to look for other problems such as inflammation and ulcers.
Removing Colon Polyps
The lining of the colon and rectum is normally smooth. Sometimes, however, growths
known as "colon polyps" appear on the lining of the large intestine. Varying in size from
pinheads to growths several inches in diameter, polyps do not usually produce any
symptoms. Contrary to popular belief, polyps affect both men and women equally. Most
colon polyps are initially non-cancerous. Nevertheless, as colon polyps continue to grow,
they often develop into cancer of the colon. Colon cancer has become quite common in our
society. In fact, nearly 1 in every 20 adult Americans will develop colon cancer in their
lifetime. Colon cancer is now the leading cause of cancer deaths in nonsmokers. Only lung
cancer takes a greater toll. It is not widely known that colon cancer now kills more women
than breast cancer and more men than prostate cancer. But, there is good news. Research
has confirmed that the single best prevention for colon cancer is the early detection and
removal of all colon polyps!!! In the past, colon polyps located beyond the range of the
proctoscope could only be removed by a major abdominal operation. Of course, this
procedure required about a week of hospitalization and over a month of time lost from work
for recovery. Fortunately, medical technology now permits the simple removal of most colon
polyps. Should a small polyp be discovered during your colonoscopy, the polyp can usually
be removed immediately. This prevents a potential colon cancer while eliminating the need
for major surgery.
The doctor removes the polyp quite simply by placing a wire loop, or "snare," around the
polyp's base and slowly tightening the loop. As the polyp is severed, a mild electric current
cauterizes the tissue to prevent bleeding. There is no pain or any sensation as the polyp is
removed. Polyp removal can usually be done on an outpatient basis. Moreover, since there
is no incision, you may usually resume normal activity the next day.
After The Test
After an outpatient colonoscopy, you will be asked to rest awhile in the recovery room. Your
companion will be asked to sit with you while the effects of the sedative begin to wear off.
Once you are more alert, the doctor will meet with you to discuss the findings and any
needed treatment. You will then be able to return home with your companion's assistance.
However, since you will still be somewhat drowsy and uncoordinated, you will be taken
directly to your car in a wheelchair by the office personnel. It is important that you go
directly home; do not stop to eat along the way. Although you may resume a regular diet at
home, you should eat lightly at first, and then gradually increase your intake of foods as
tolerated. Since air was placed in the colon during the examination, you may experience the
discomfort of mild "gas pains" for several hours until the gas is expelled. Because of the
sedation's lingering effects, you should not drive, operate any machinery, drink alcohol, or
engage in any vigorous activity for the remainder of the day. If the test is performed on an
inpatient basis, you will be taken back to your hospital bed for recovery. If any specimens
or polyps were extracted during the examination, the doctor will contact both you and your
personal physician when the laboratory results become available. Further treatment or
tests, if necessary, will be discussed at that time.
Is This Test Dangerous?
While every medical procedure involves some degree of risk, complications rarely occur in
patients undergoing colonoscopy. With the advent of flexible fiberoptic instruments, this test
has become a safe and simple method of directly examining the lower digestive tract. When
performed by a physician who is specially trained and experienced in the procedure, the
benefits of colonoscopy far exceed the risks.
Your doctor is a Gastroenterologist. In addition to standard medical training, he has
received special instruction in diseases of the digestive system and has been thoroughly
trained in the safe and proper operation of the colonoscope. The combination of his
expertise and your cooperation should make this test as safe and simple as possible.
However, as with all medical procedures, complications can occur.
The principal risks are perforation of the colon (a tear through the bowel wall) or bleeding.
Although perforation generally requires surgery, certain cases may be treated with
antibiotics and intravenous fluids. Bleeding may occur at the site of either a biopsy or polyp
removal. Typically minor in degree, such bleeding may stop on its own or be controlled by
cauterization. Occasionally, surgery is necessary. Fortunately, both perforation of the colon
and bleeding are quite rare. Because bleeding may sometimes occur up to three weeks after
a colon polyp has been removed, you should not plan to travel to any remote areas without
medical access during this period of healing.
Other possible risks include drug reactions and complications related to other diseases that
you may have. Consequently, you should inform your doctor of all allergic tendencies and
medical problems. Occasionally, the site of the sedative injection may become inflamed and
tender for a short time. This is not serious. If inflammation occurs, applying warm
compresses to the area is usually helpful. While any of these complications may occur, it is
well to remember that each of them occurs quite infrequently. Your doctor will be happy to
discuss the above risks with you further, especially with regard to your particular situation
and need for colonoscopy.
How About AIDS?
Due to the recent extensive coverage of AIDS by the media, some patients have expressed
the concern that they might, in fact, contract AIDS through this examination. Be assured
that this is not the case. All our instruments are thoroughly cleaned and undergo high-level
disinfection after each use. Only techniques known to kill all disease-causing bacteria and
viruses, including the hepatitis and AIDS virus, are employed in this process.
A Valuable Tool....
In summary, colonoscopy is a valuable tool for the diagnosis and treatment of many
diseases of the large intestine. Even when x-rays are normal, the cause of symptoms such
as rectal bleeding or change in bowel habits may be determined by colonoscopy. It is also
useful in the diagnosis and follow-up care of patients with colitis. Through colonoscopy, the
detection and removal of colon polyps, and thus the prevention of colon cancer, are made
possible. Periodic colonoscopy is a valuable tool in monitoring patients with previous polyps,
colon cancer, or a family history of colon cancer. In essence, colonoscopy is a safe and
worthwhile procedure that is extremely well tolerated. If you have any questions about your
need for colonoscopy, do not hesitate to ask your doctor.