Colonoscopy With A Polypectomy

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What Is A Colonoscopy?

A colonoscopy is a medical procedure used to examine the inside of the colon (large intestine) and rectum. During the procedure, a thin, flexible tube called a colonoscope is inserted through the rectum. The colonoscope has a tiny camera at its tip, which allows your gastroenterologist to view the entire length of the colon on a video monitor. This procedure is typically performed to screen for colorectal cancer, investigate symptoms like abdominal pain, rectal bleeding, or changes in bowel habits, and to identify conditions such as polyps, diverticulosis, and inflammatory bowel disease (IBD).

Polypectomy During Colonoscopy

One of the key benefits of a colonoscopy is the ability to remove polyps (growths on the inner lining of the colon) during the procedure. This process is known as a polypectomy. Most polyps are non-cancerous, but some may develop into cancer over time. Removing them early helps prevent the progression to colorectal cancer.

A colonoscopy may also be performed on an asymptomatic patient at age 50, or sooner, depending on the patient’s history, to screen for colon cancer and polyps

What Should I Expect The Day Before My Colonoscopy?

The day before your colonoscopy is crucial for ensuring a successful exam. You will receive detailed instructions from your doctor on how to prepare, and it’s very important to follow these guidelines closely. Proper bowel preparation is essential because it helps clear out the colon, allowing your gastroenterologist to get a clear view during the procedure.

Dietary Instructions

• Most patients will need to follow a clear, liquid diet the entire day before the exam. This means you can consume water, clear broth, apple juice, white grape juice, clear sodas, tea, black coffee (no cream or milk), and clear sports drinks. Avoid red, purple, or blue liquids, as they can be mistaken for blood during the procedure.
• Solid foods and dairy products should be avoided to ensure the colon is completely empty.

Bowel Preparation (Laxatives)

• You will be prescribed a laxative solution or preparation kit designed to cleanse the colon. This may include a combination of pills and liquid solutions. Common options include polyethylene glycol (PEG) solutions, sodium phosphate tablets, or magnesium citrate.
• It’s important to drink the entire prep solution as directed, even if you feel your bowel movements are already clear. Completing the prep ensures a thorough clean-out of the colon.

Medication Instructions

• In most cases, you can continue taking your regular medications. However, if you are on blood thinners like Coumadin, Warfarin, Plavix, aspirin, or non-steroidal anti-inflammatory drugs (NSAIDs), your doctor may provide special instructions. These medications can increase the risk of bleeding, so adjustments might be needed.
• For patients with diabetes, adjustments may also be necessary to manage blood sugar levels, especially since you will be consuming fewer calories the day before the exam.

Fasting Before the Procedure

• You must stop eating or drinking (except water) after midnight on the night before your colonoscopy. This includes all liquids except necessary medications taken with a small sip of water.

By following these instructions carefully, you can help ensure your colonoscopy goes smoothly and provides the most accurate results.

What Happens On The Day Of My Colonoscopy?

You will be asked to arrive at the Endoscopy center 1 to 1.5 hours before your exam. This is to allow time to fill out paperwork and prepare for the exam. You will be asked to change into a medical gown. An intravenous (IV) catheter will be started in your arm so that sedation can be administered. You will be connected to equipment that will allow the doctor and staff to monitor your heart rate, blood pressure, pulse, electrocardiogram, breathing, and oxygen level during and after the exam.

Once in the exam room, you will be asked to lie on your left side on the stretcher. The IV sedation will be started. Small amounts are given at a time to assure that you do not react to the medication and to provide only the amount you need individually. Once an adequate level of sedation is achieved, the physician will perform a rectal exam. The colonoscope will then be gently inserted into the rectum. The scope will be carefully advanced throughout the colon to where the small bowel and colon meet. A small amount of air is injected through the scope into the colon to help the physician see. Any fluid remaining in the colon after the preparation can be washed and suctioned out through the scope. Depending on the findings of the exam, several things can be done at the time of the procedure including biopsies, removal of polyps, and control of bleeding. At the end of the procedure, as much of the air and remaining fluid as possible is suctioned out of the colon through the scope. Depending on the findings, the exam takes approximately 15-30 minutes.

After the exam is complete, the patient is taken to the recovery room to be monitored while the sedation starts to wear off. The amount of sedation used during the exam and the patient’s individual response to the medication will dictate how quickly the patient wakes up, though most patients are awake enough for discharge within 45-60 minutes. You will not be allowed to drive for the rest of the day; therefore, you will need to arrange for a ride home. You will also be instructed not to work, sign important papers, or perform strenuous activities for the rest of the day. Most patients are able to eat and drink normally after their discharge from the Endoscopy unit; however, specific instructions regarding activity, eating, and medications will be given to the patient prior to discharge.

When Will I Get My Results?

After your colonoscopy, your doctor or nurse will review the findings with you. However, due to the effects of the sedation, many patients may not fully remember this discussion. For this reason, it’s highly recommended to bring a friend or family member with you to the appointment who can also listen to the results and take notes if needed.

Immediate Results

• If any polyps or abnormalities are found and removed during the procedure, your doctor will typically provide a preliminary explanation right after the exam.
• You will receive a typed report with an overview of the procedure and any initial findings before you leave the facility.

Biopsy Results

• If a biopsy (tissue sample) is taken during the colonoscopy, the sample will be sent to a laboratory for further analysis. This process usually takes about 5-7 days.
• Your doctor’s office will contact you with the results once they are available, either by phone or through a patient portal. In some cases, a follow-up appointment may be scheduled to discuss the findings in detail.

What to Do Next

• Make sure you have a plan for transportation home, as you may still feel drowsy from the sedation.
• If you don’t hear back about your biopsy results within a week, it’s a good idea to follow up with your doctor’s office.

This process ensures you get a clear understanding of your colonoscopy results and any next steps needed for your health.

What Are The Risks Of A Colonoscopy?

A colonoscopy is considered a safe and routine procedure, especially when performed by an experienced gastroenterologist. However, like any medical procedure, it does carry some risks. Overall, complications occur in less than 1% of patients, and most are not life-threatening. Understanding these potential risks can help you feel more prepared and informed before your exam.

1. Reactions to Sedation

• During a colonoscopy, you will receive sedation to help you relax and minimize discomfort. While reactions are rare, they can include:
  • Allergic reactions to the medications.
  • Difficulty breathing, especially in patients with existing respiratory conditions.
  • Heart or blood pressure changes, which are typically monitored closely by the medical team.
  • Vein irritation at the injection site (known as phlebitis), which usually resolves without treatment.

2. Bleeding

• Minor bleeding can occur if a biopsy is taken or a polyp is removed. In most cases, this bleeding is minimal and stops on its own.
• Significant bleeding is uncommon but may require additional treatment, such as a blood transfusion or hospitalization. Bleeding can happen during the procedure or up to 2 weeks afterward, especially if a large polyp was removed.

3. Perforation (Colon Puncture)

• A perforation is a tear or hole in the colon wall. This is a rare but serious complication, occurring in about 1 in 1,000 procedures.
• If a perforation occurs, it may be detected immediately during the exam or later, as symptoms develop. Most cases require surgical intervention and hospitalization to repair the tear.

4. Missed Abnormalities

• Although a colonoscopy is the gold standard for detecting colorectal cancer and polyps, no test is perfect. There is a small risk that polyps or cancers may be missed, especially if the bowel preparation was inadequate or if the growths were very small.

5. Post-Procedure Symptoms

• It’s important to be aware of potential symptoms that may indicate a complication after the procedure. Contact your doctor immediately if you experience:
  • Severe or worsening abdominal pain
  • Heavy rectal bleeding
  • Fever or chills
  • Dizziness or fainting

Consent and Communication

• Before the procedure, you will review a consent form with the nursing staff. This is your opportunity to ask any questions and discuss any concerns with your doctor.

While complications from a colonoscopy are rare, it’s crucial to understand the risks and follow your doctor’s advice to minimize them. With careful preparation and attention to any post-procedure symptoms, you can help ensure a safe and successful exam.

What Are The Alternatives To A Colonoscopy?

While a colonoscopy is considered the gold standard for evaluating and treating abnormalities in the colon, there are several alternative tests available. The choice of an alternative depends on the reason for the exam, your risk factors, and your overall health. Keep in mind that most alternatives are diagnostic only, meaning they can detect abnormalities but cannot treat or remove them. If a polyp or suspicious growth is found, a colonoscopy or surgery may still be required.

1. Virtual Colonoscopy (CT Colonography)

• A virtual colonoscopy uses a CT scan to create detailed images of the colon. It is a non-invasive procedure that can detect polyps, tumors, and other abnormalities.
• Pros: No sedation is needed, and it is less invasive than a traditional colonoscopy.
• Cons: It still requires bowel preparation, and if a polyp is detected, a standard colonoscopy is needed to remove it or perform a biopsy.

2. Flexible Sigmoidoscopy

• A flexible sigmoidoscopy is similar to a colonoscopy but examines only the lower part of the colon (the rectum and sigmoid colon). It uses a shorter, flexible tube with a camera.
• Pros: It is quicker, usually does not require full sedation, and has a shorter recovery time.
• Cons: It only evaluates about one-third of the colon, so abnormalities in the upper colon can be missed.

3. Fecal Immunochemical Test (FIT) and Fecal Occult Blood Test (FOBT)

• Both the FIT and FOBT tests analyze a stool sample for hidden blood, which may indicate the presence of polyps or colorectal cancer.
• Pros: Non-invasive, easy to do at home, and does not require bowel preparation.
• Cons: These tests only detect blood, not polyps or cancer directly. If blood is detected, a colonoscopy is usually recommended for further evaluation.

4. Barium Enema (Lower GI Series)

• A barium enema involves filling the colon with a liquid called barium, followed by X-rays. The barium helps outline the colon on the X-ray images.
• Pros: It can provide good visualization of the colon structure.
• Cons: It requires bowel preparation and may not detect small polyps. If abnormalities are found, a follow-up colonoscopy may be needed.

5. Capsule Endoscopy

• In capsule endoscopy, you swallow a small, pill-sized camera that takes pictures as it travels through the digestive tract.
• Pros: Non-invasive and can help visualize the small intestine, which is not easily examined with a standard colonoscopy.
• Cons: It is primarily used for small intestine evaluation, not the colon. If suspicious areas are detected in the colon, a traditional colonoscopy is required for treatment.

6. Cologuard (Stool DNA Test)

• Cologuard is a home-based test that analyzes stool for DNA markers associated with colorectal cancer and precancerous polyps.
• Pros: Non-invasive and does not require bowel preparation.
• Cons: It can produce false positives or false negatives. A positive result often necessitates a follow-up colonoscopy.

Which Test Is Right for You?

• The best alternative depends on your personal risk factors, medical history, and the reason for needing the exam. Discuss these options with your doctor to determine the most suitable approach.
• Keep in mind that while alternatives can provide valuable information, they may not be as comprehensive as a colonoscopy, especially when it comes to detecting and treating abnormalities.

The Gold Standard for Colon Cancer Screening

• Complete Examination: A colonoscopy examines the full length of the colon and rectum, making it the most thorough screening tool available. Other tests, like sigmoidoscopy, only evaluate a portion of the colon.
• Polyp Detection and Removal: During a colonoscopy, if the doctor finds any polyps (small growths on the inner lining of the colon), they can be removed immediately (a process known as polypectomy). Removing polyps helps prevent them from developing into cancer.
• Accurate Diagnosis: A colonoscopy allows for direct visualization of the colon lining, making it more accurate in detecting abnormalities compared to imaging tests or stool-based screenings.

Limitations of Other Screening Methods

• Alternative tests, such as FIT, FOBT, Cologuard, and virtual colonoscopy, can help detect signs of cancer or polyps, but they are only diagnostic. They cannot remove polyps or treat abnormalities if detected.
• If any of these tests return a positive result, a follow-up colonoscopy is usually necessary to confirm the findings and remove any polyps.

Preventive Power

• One of the most significant advantages of a colonoscopy is its preventive capability. By identifying and removing polyps before they turn into cancer, a colonoscopy not only detects cancer early but can also prevent it altogether.
• This makes it a powerful tool in reducing the risk of developing colorectal cancer, especially for individuals at average or high risk due to age, family history, or other factors.

In summary, while there are several methods available for colorectal cancer screening, a colonoscopy remains the most comprehensive and effective option. It’s the only test that combines detection, diagnosis, and treatment in one procedure, making it the gold standard for protecting your colon health.