Colonoscopy

What is a colonoscopy?

Colonoscopy is a procedure to check the inside of your entire large intestine or colon using a long, flexible tube (a colonoscope). The tube has a light and camera on one end. It is inserted through the anus and rectum and moved into the colon and will inject air in your bowel to make it easier to see inside.

Why do you need a specialist?

A specialist in gastrointestinal diseases has received special training in colonoscopy. They do more colonoscopies than any other specialty. Studies have shown that the non-specialists are five times more likely to miss a colorectal cancer during colonoscopy than a GI Specialist (Rex DK, Rahmani E, Haseman JH, et al.). Proper training in colonoscopy is not only crucial for achieving high completion rates, but also to accurately interpret abnormal results.

How often do I complete the colonoscopy?

Experienced colonoscopists reach the end point; the cecum (complete colonoscopy) in more than 99% of cases and in more than 95% of patients who are undergoing screening. Experienced colonoscopist will enter the ileum (the last part of the small bowel) in 85% of the cases. My rates of complete colonoscopy (caecal intubation) is above 99% and rate of entering the ileum (Ileal intubation) is over 96%.

Do you have to get admitted for colonoscopy?

There are two main methods of bowel preparation for colonoscopy (to clean your colon in-order to see the inner wall clearly).

If you are having normal renal functions, two phospho soda laxative (Fleet) 45ml doses 12hrs apart started 18hrs before intended time of the colonoscopy with plenty of water intake throughout will clean your colon adequately.

Otherwise, 4 satchets of polyethylene glycol (Kleen-prep): each dissolved in 1 later of water taken over 8 hours starting 18hours prior to the intended time of colonoscopy with plenty more water intake throughout is necessary.

Both those bowel prep methods can cause complications which require either stopping of the preparation or arranging some other test or procedures urgenty. Therefore its advisable to do the bowel prep as an in-patient.

Why you might need a colonoscopy?

Colonoscopy is a gold standard tool to diagnose many colonic diseases and also helps to treat some lower intestinal problems. It can be used to come to a diagnosis in following lower GI problems that one might have:

Colonoscopy can diagnose following diseases:

Colonoscopy is also used to screen for colorectal cancer which means looking for cancer in people who don’t have any symptoms; especially if they have high genetic risk of developing colorectal cancer. Furthermore colonoscopy is used for surveillance of already diagnosed patients such as in those who have pre-cancerous or inflammatory conditions and who already had cancer or high risk conditions that has been successfully treated.

A colonoscopy can be used therapeutically:

What are the risks of a colonoscopy?

As with any invasive procedure, complications can happen. Complications pertaining to colonoscopy include, but are not limited to:

How do I get ready for a colonoscopy?

First make sure that the surgeon knows if you are:

You may need to take antibiotics before the colonoscopy if you:

If everything so far is in order, its necessary to prepare your bowel for the test.

Last solid meal should be 18 hours prior to the intended time of colonoscopy. Only clear liquids allowed afterwards.

Bowel Preparation

We employ mainly two methods of bowel prep.

If the patient is having normal renal functions, we use 2 x fleet (phospho soda) 45ml doses 12hrs apart started 18hrs before intended time of the colonoscopy with plenty of water intake throughout.

Otherwise, we use 4 satchets of polyethylene glycol (Kleen-prep): each dissolved in 1 litre of water taken over 8 hours starting 18 hours prior to the intended time of colonoscopy with plenty more water intake throughout.

Both those bowel prep methods can cause complications. therefore its advisable to do the bowel prep as an in-patient. The patient should open bowel 15-20 times. Towards the latter part, bowel openings should look clear.

You will be asked to remove any jewelry or other objects that might get in the way during the procedure. You may be asked to remove your clothing. If so, you will be given a gown to wear.

An IV (intravenous) line will be inserted in your arm or hand. A sedative or a pain medicine will be injected into the IV. The patient will be given pain medicine and a medicine to relax (a sedative) before the procedure. Your heart rate, blood pressure, respiratory rate, and oxygen level will be checked during the procedure. You will be given oxygen to breathe in.

You will be asked to lie on your left side with your knees pulled up towards your chest.

A lubricated tube will be put into your anus and moved into your rectum and colon. You may feel mild pain, pressure, or cramping during the procedure. You may also be asked to change your position to help the tube pass through. Air may be injected into your bowel. This may make it easier to see the inside surfaces. The surgeon will check your colon and may take photos. If a polyp is seen, it may be taken out / biopsied Or it may be left there with ink injected to mark it until another procedure is done. After the procedure is over, the tube will be taken out.

What happens after a colonoscopy?

After the procedure, you will be taken to the recovery room to be watched. Your recovery process will depend on the type of sedative you had. Once your blood pressure, pulse, and breathing are stable and you are awake and alert, you will be taken to your hospital room. Or you may be discharged to your home.

You are not allowed to drive on the same day. you need someone to take you home if you are discharged. You can usually eat whatever you feel you can tolerate after the procedure. You may pass gas (be flatulent) and feel gas pains after the procedure. This is normal. Walking and moving about may help to ease any mild pain. You should not drink alcohol for at least 24 hours. You may be asked to drink extra fluids to make up for the water you lost as you got ready for the procedure.

Signs of complications:

If you experience any of the above, you may be having a complication of the procedure and may need additional testing or additional procedures. If you are already admitted in a hospital, you may have to stay longer. If you are at home, you need to come to a hospital as soon as possible.