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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:
- Bleeding from rectum
- Mucous passage from rectum
- Unexplained diarrhoea / loose stools
- Blood in the stool
- Positive fecal occult blood test
- Lower abdominal pain
- Altered bowel habits
- Partial or complete bowel obstruction
- Unexplained weight loss
- Lumps at anus / Haemorrhoids (piles)
- Before or after some surgeries
Colonoscopy can diagnose following diseases:
- Colo-rectal cancer
- Inflammation - Proctitis / colitis
- Diverticulosis / Diverticulitis
- Strictures - Malignant / Benign
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:
- To remove most colo-rectal polyps
- To remove some early tumors
- To treat ulceration
- To stop active bleeding
- To dilate narrowed areas (strictures) of the colon
- To remove foreign objects in the colon
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:
- Continued bleeding from tissue sampled site (biopsy) or polyp removal site
- Nausea, vomiting, bloating because of the medication used or air insufflation
- Rectal irritation caused by the procedure or by the bowel preparation
- Bad reaction to medicine (sedative)
- Very rarely a hole occurred through (perforation of) the colonic wall
- Extremely rarely, damage to spleen causing internal bleeding
- Other problems related the patients pre-existing condition such as chest pain
How do I get ready for a colonoscopy?
First make sure that the surgeon knows if you are:
- Currently pregnant
- Having diabetes
- Having lung conditions
- Having heart conditions
- Having renal dysfunction
- Having bleeding disorders
- Allergic to anything
- On medications that affect blood clotting (adjustments or stopping of these medications may be required before the colonoscopy)
You may need to take antibiotics before the colonoscopy if you:
- Have an artificial heart valve
- Have ever been told you need to take antibiotics before a dental or surgical procedure
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.
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:
- Fever or chills
- Frequent bloody stools
- Belly pain or swelling
- Your belly feels hard
- Not able to pass gas
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.