Colonoscopy is the visual examination of the large intestine (colon) using a lighted, flexible fiber optic video endoscope. The colon begins in the right-lower abdomen and looks like a big question mark as it moves up and around the abdomen, ending in the rectum. It is 5 to 6 feet long. The colon has a number of functions including withdrawing water from the liquid stool that enters it so that a formed stool is produced.

Equipment
Reasons for the Exam
Preparation
The Procedure
Benefits
Alternative Testing
Side Effects and Risks
Summary
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Equipment
The flexible colonoscope is a remarkable piece of equipment that can be directed and moved around the many bends in the colon. The video endoscope uses a tiny, optically sensitive computer chip at its end to transmit electronic signals to a large video screen. An open channel in these scopes allows other instruments to be passed through in order to perform biopsies, remove polyps or inject solutions.

Reasons for the Exam
There are many types of problems that can occur in the colon. The medical history, physical exam, laboratory tests and x-rays can provide information useful in making a diagnosis. Directly viewing the inside of the colon by colonoscopy is usually the best exam. Colonoscopy is used for:

• Colon cancer---a serious but highly curable malignancy
• Polyps---fleshy tumors which usually are the forerunners of colon cancer
• Colitis (Ulcerative or Crohn's)--- chronic recurrent inflamation of the colon
• Diverticulosis and Diverticulitis--- pockets along the intestinal wall that develop over time and can become infected
• Bleeding lesions---bleeding may occur from different points in the colon
• Abdominal symptoms, such as pain or discomfort, particularly if associated with weight loss or anemia
• Abnormal barium x-ray exam
• Chronic diarrhea, constipation, or a change in bowel habits
• Anemia

Preparation
To obtain the full benefits of the exam, the colon must be clean and free of stool. The patient receives instructions on how to do this. It involves drinking a solution which flushes the colon clean or talking laxatives and enemas. Usually the patient drinks only clear liquids and eats no food for the day before the exam. You will be advised regarding the use of regular medications during that time. more detail...

The Procedure
Colonoscopy is usually performed on an outpatient basis in our office; some insurance carriers will mandate that it be done in the hospital.

You will come to out office in a fasting state. As per our instructions there is nothing to eat or drink (including water) unless instructed otherwise from 11PM the night before the colonoscopy. You will be brought to the back and asked to put on an examination gown. Our anesthesiologist will be introduced to you. They will take a history and do an examination. An intravenous (IV) line will be place and sterile fluids will be administered to you.

You will then be escorted to the procedure room and asked to lie down on the table. Several pieces of monitoring equipment will be attached to you including a blood pressure monitor, a electrocardiogram monitor, and an oxygen saturation monitor (this will measure how much oxygen is getting into your blood from your lungs. You will also have oxygen administered to you via either a face mask or nasal cannulas. After this is done you will be asked to roll onto your left side as though you were going to sleep.

The patient is then sedated via medications given through the IV line. The colonoscope is inserted through the anus after a rectal examination is performed and moved gently around the bends of the colon. If a polyp is encountered it is removed. Other procedures that can be performed during colonoscopy include biopsy(s) and brushings. The procedure takes 15 to 30 minutes and is seldom if ever remembered by the patient. Following the procedure your vital signs will be monitored and you will be given a beverage and some food. It is normal to experience mild cramping or abdominal pressure following the exam. This usually subsides in an hour or so. Following your recovery you will be taken to the Doctors office to discuss the findings and future plans. If a biopsy was done or a polyp removed, the results normally take five (5) business days to be returned to our office.

Benefits
A colonoscopy is performed to identify and/or correct a problem in the colon. The test enables a diagnosis to be made and specific treatment can be given. If a polyp is found during the exam, it can he removed at that time, eliminating the need for a major operation later.

If a bleeding site is identified, treatment can be administered to stop the bleeding. Other treatments can be given through the endoscope when necessary.

Alternative Testing
Alternative tests to colonoscopy include a barium enema or other types of x-ray exams that outline the colon and allow a diagnosis to be made. Study of the stools and blood can provide indirect information about a colon condition. These exams, however, do not allow direct viewing of the colon, removal of polyps, or the completion of biopsies. Virtual colonoscopy is a new modality that is not covered by insurance carriers. It also has many shortcomings including missing small lesions, an inability to treat any abnormalities that are found (like a polyp) that would require you to have a colonoscopy in any event.

Side Effects and Risks
Bloating and distension typically occur for about an hour after the exam until the air is expelled. Serious risks with colonoscopy, however, are very uncommon. One such risk is excessive bleeding, especially with the removal of a large polyp. In rare instances, a tear in the lining of the colon can occur. These complications may require hospitalization and, rarely, surgery. Quite uncommonly a diagnostic error or oversight may occur.

There can also be a reaction to the sedation which is very rare. In similar fashion to Upper Endoscopy you are instructed to go home with an escort following the conclusion of the colonoscopy.

Summary
Colonoscopy is an outpatient exam that is performed with the patient sedated. The procedure provides significant information that can be used to determine which specific treatment can or will be given. In certain cases, therapy can be administered directly through the colonoscope like removing a polyp. Serious complications rarely occur from colonoscopy. We are available to answer any questions you have.