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Gastroenterology Clinic of San Antonio

Colonoscopy

Colonoscopy is a procedure that enables your physician to examine the lining of the colon (large bowel) for abnormalities by inserting a flexible tube into the anus and advancing it slowly into the rectum and colon. The endoscope has its own video camera and light source, and is about the thickness of your finger.

WHY IS COLONOSCOPY DONE?

Colonoscopy is usually performed to evaluate symptoms of persistent lower abdominal pain, chronic diarrhea. It is also the best test for finding the cause of active or occult (slow, chronic) bleeding from the lower gastrointestinal tract. Colonoscopy is more accurate than x-ray films for detecting inflammation, ulcers or tumors of the colon. Colonoscopy can detect early cancer and can distinguish between benign and malignant (cancerous) conditions when biopsies (small tissues sample) of suspicious areas are obtained. Biopsies are taken for many reasons and do not necessarily mean that cancer is suspected. A cytology test (introduction of a small brush to collect cells) may also be performed. Colonoscopy is also used to treat conditions present in the lower gastrointestinal tract. A variety of instruments can be passed through the colonoscope that allow many abnormalities to be treated directly with little or no discomfort, for example, stretching narrowed areas, removing polyps (usually benign growths), treating lower gastrointestinal bleeding. Safe and effective endoscopic control of bleeding has reduced the need for transfusions and surgery in many patients.

WHAT ABOUT MY CURRENT MEDICATIONS?

Most medications may be continued as usual, but some medications can interfere with the preparation or the examination. It is therefore best to inform your physician of your current medications as well as any allergies to any medications several days before to the examination. Aspirin products, arthritis medications, anticoagulants (blood thinners), insulin, and iron products are examples of medications whose use should be discussed with your physician prior to examination. You should alert your physician if you require antibiotics prior to undergoing dental procedures, since you may need antibiotics prior to colonoscopy as well.

WHAT CAN BE EXPECTED DURING COLONOSCOPY?

Colonoscopy is usually well tolerated and rarely causes much pain. There is often a feeling of pressure, bloating, or cramping at various times during the procedure. Your doctor will give you a sedative through a vein to help you relax and better tolerate any discomfort from the procedure. You will be lying on your left side or on you back while the colonoscope is advanced through the rectum and colon. As the instrument is withdrawn, the lining of the intestine is carefully examined. The procedure usually takes anywhere from 15 to 60 minutes. In some cases, passage of the colonscope through the entire colon to its junction with small intestine cannot be achieved. The physician will decide if the limited examination is sufficient or if other types of examinations are necessary.

WHAT IF THE COLONOSCOPY SHOWS SOMETHING ABNORMAL?

If your doctor thinks an area of the bowel needs to be evaluated in greater detail, a forceps instrument is passed through the colonoscope to obtain a biopsy (a sample of the colon lining). This specimen is submitted to the pathology laboratory for analysis. If colonoscopy is being performed to identify sites of bleeding, the areas of bleeding may be controlled through the colonoscope by injecting certain medications or by coagulation (sealing off bleeding vessels with heat treatment). If polyps are found, they are generally removed. None of these additional procedures typically produce pain. Remember, the biopsies are taken for many reasons and do not necessarily mean that cancer is suspected.

WHAT ARE POLYPS, AND WHY AND HOW ARE THEY REMOVED?

Colon Polyps

Polyps are abnormal growths from the lining of the colon which vary in size from a tiny dot to several inches. The majority of polyps are benign (noncancerous) but the doctor cannot always tell a benign from a malignant (cancerous) polyp by its outer appearance alone. For this reason, removed polyps are sent for tissue analysis. Removal of colon polyps is an important means of prevention and early detection of colon cancer. Tiny polyps may be totally destroyed by fulguration (burning), but larger polyps are removed by a technique called snare polypectomy. The doctor passes a wire loop (snare) through the colonscope and severs the attachment of the polyp from the intestinal wall by means of an electrical current. You should feel no pain during the polypectomy. There is a small risk (0.1%) that removing a polyp will cause bleeding or result in a burn to the wall of the colon, which require emergency surgery.

WHAT HAPPENS AFTER COLONOSCOPY?

After the test, you will be monitored in the endoscopy area until most of the effects of the medication have worn off. You may have some cramping or bloating of air introduced into your colon during the test. This should disappear quickly with passage of flatus (gas). In most circumstances, your doctor can inform you of your test results on the day of the procedure; however, the results of any biopsies or cytology samples will take several days.

WHAT ARE POSSIBLE COMPLICATIONS OF COLONOSCOPY?

Colonoscopy and polypectompy are generally safe when performed by physicians who have been specially trained and are experienced in these endoscopic procedures. One possible uncommon complication is a PERFORATION tear through the bowel wall that could require surgery. BLEEDING may occur in approximately 0.1% from a biopsy site or where a polyp was removed. It can occur during the procedure or be delayed up to 7 to 10 days later. It is usually minor and stops on its own or can be controlled through the colonoscope. Rarely blood transfusions or surgery may be required. PHLEBITIS or localized irritation of the vein into where medication was injected may rarely cause a tender lump that may last several weeks, but this will go away eventually. The application of heat packs or hot moist towels may help relieve the discomfort. Other potential risks include a REACTION TO THE SEDATIVES used and complications from heart or lung diseases. Although complications after colonoscopy are uncommon, it is important for you to recognize early signs of any possible complication. Contact your physician who performed the colonoscopy if you notice any of the following symptoms: severe abdominal pain, fever and chill, or rectal bleeding of more than one half cup. Bleeding can occur several days after polypectomy.

WHAT PREPARATION IS REQUIRED?

There are several different preps offered. Depending on the doctor and the health conditions of the patient, a prep will be recommended.

The colon must be completely clean for the procedure to be accurate and complete. Follow your doctor’s instructions carefully. If you do not, the procedure may have to be canceled and the preparation repeated later. You can have as much of the clear liquids as you want until midnight. It is easy to become dehydrated during your preparation. Drink at least 2 liters of fluid prior to starting your laxative. If you experience any problems, such as nausea or vomiting, please contact our office. A loose or watery bowel movement will occur within 1-2 hours of beginning the laxative and is expected. Results vary with each individual. You may take your medications in the morning with the exception of NO INSULIN, OR DIABETES PILLS.

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