Tremendous progress in the field of
fiberoptics has made it relatively simple for your doctor to examine
the entire large intestine, or colon, with a procedure called
colonoscopy. More accurate than a barium enema x-ray and much
simpler than exploratory surgery, colonoscopy is a safe and highly
effective diagnostic technique.
assessment, your doctor has decided that a colonoscopy is necessary
to better evaluate and treat your condition. Since your cooperation
is essential for a successful examination, it is important that you
understand exactly what is to be done and why. If you have any
additional questions or concerns after reading this article, please
ask your doctor.
Colonoscopy is a
medical term that has two parts - colono which refers to the colon,
or large intestine, and scopy which means "looking into." Therefore,
colonoscopy is a test that enables your doctor to look inside your
colon. The instrument used to perform this test is the colonoscope:
a long, flexible tube about the width of your index finger. Within
the end of this tube is a miniaturized color-TV camera with a
wide-angle lens. After passing this "scope" through the rectum and
into your colon, your doctor then directly examines the lining of
your lower digestive tract on a television monitor. In this manner,
it is possible to evaluate intestinal inflammation, ulceration,
bleeding, diverticulitis, colitis, colon polyps, tumors, etc.
As part of your assessment, you may have undergone a
barium enema examination of the colon, or "lower GI series." This
technique, which utilizes x-rays, is helpful in identifying any
areas of possible abnormality. X-rays are only shadows, however, and
often do not fully demonstrate what is wrong. For example, the
barium enema x-ray may miss nearly forty percent of colon polyps.
In the past, you also may have undergone a proctoscopic
examination of the lower colon and rectum. Performed with a short,
rigid, hollow tube, this limited procedure enabled the doctor to
examine only the last ten inches of the large intestine. In most
offices, the proctoscope has now been replaced by the flexible
sigmoidoscope. This newer device enables your doctor to examine the
last two feet of the colon while its flexibility affords the patient
much greater comfort than does the rigid type of scope.
colonoscope offers a still greater advantage. With this longer
flexible instrument, your doctor is usually able to directly examine
the entire length of your colon - all five feet of its numerous
twists and turns. In this manner, your doctor can be most certain
about the condition of your colon.
How You Can
Your cooperation is essential for a successful
examination. There are certain things you can do to help before the
A colonoscopy exam requires a thorough
cleansing of the large intestine so that nothing impedes your
doctor's view. The colon must be completely free of all solid
waste. Since particles of stool can interfere with the
examination, you will require a special dietary
and laxative preparation on the day prior to the test. To be
sure that you fully understand all aspects of the preparation, the
GI Assistant or a member of the Nursing staff will review the
preparation with you. It is critical that you follow the
instructions as given. If the colon is not clean, the test - as
well as the preparation - may have to be rescheduled. A few hints:
It is best not to be constipated before the laxative preparation.
This may lead to a temporary backup of the laxative solution,
cramps, bloating, nausea, and vomiting. If you tend to be
constipated, take one or two ounces of Milk of Magnesia the day
before the laxative prep to "open up your pipes." This will make
the actual preparation easier. If you develop mild distress during
your prep, simply stop it for an hour or two and then resume it
where you left off. If you develop severe abdominal cramps or
persistent nausea and vomiting, stop the prep and call our office
to reach our doctor on call. Of course, the laxative preparation
will cause you to have many bowel movements. This may cause some
rectal irritation and a small amount of bleeding. Many patients
find that using Charmin Plus toilet tissue minimizes such rectal
irritation. A nonprescription 1% hydrocortisone cream may also be
soothing when applied to the rectal area after each bowel
movement. Please avoid foods with many small seeds for a few days
before the exam. They tend to linger in the colon and can clog our
instruments. In addition, you must avoid all red-colored Jello
products during your preparation as their red dye masks the lining
of the colon.
Medications containing iron or Metamucil-like
fiber can impair your doctor's view of the colon. If possible,
they should be temporarily discontinued several days before the
test. If you are taking chronic aspirin or Persantine therapy,
diabetic medication, or the blood-thinner Coumadin, you will
require special preparation and adjustment of your medicines
before the test. Please call our office for instructions. All
other routine medications may continue to be taken with a small
sip of water, even on the day of the exam.
- What To Wear
You will have to change into a patient gown
before the examination. If this test is being done on an
outpatient basis, you should wear, loose, comfortable, casual
clothing that is easily removed and folded. Avoid girdles,
pantyhose, or tight-fitting garments. Please leave your jewlery,
valuables, and high heels at home. Transportation To minimize any
discomfort, you will receive an injection before the colonoscopy.
As this medication will make you drowsy for several hours, you
cannot safely drive a car for the remainder of the day. Therefore,
if this test is being done on an outpatient basis, a family member
or friend must accompany you to the office in order to drive you
home. If possible, you should choose someone with whom the doctor
can freely discuss the results of your test. We request that your
companion remain in the office during the test. You should arrive
several minutes before your appointment and plan to stay
approximately two hours.
If the test is
being done on an inpatient basis, a driver will not be needed.
After the test, you will simply return to your hospital room to
sleep off the remainder of the medication. You will be asked to
remain in bed several hours to allow the sedation to wear off
- Your Permission
If you have any questions or concerns
about this test, do not hesitate to ask your doctor about them. To
signify that you completely understand what this test involves,
you will be asked to sign a written consent form, or "permit,"
before the test begins.
Prior to the test,
you will be asked to remove your clothing and to slip into a patient
gown. After signing the permission form, you will be positioned
comfortably on your left side on the padded colonoscopy table. A
small painless oximeter probe will be placed on your fingertip to
monitor your pulse rate and breathing function during the exam. A
thin nasal oxygen tube may be used to administer low flow oxygen
during the exam. Then you will be given an intravenous injection of
Demerol (pain killer) and Versed (tranquilizer); these medications
will make you drowsy and relaxed, thus minimizing any discomfort
during the examination. Please inform the doctor if you are allergic
to Demerol or Versed, or if you chronically take narcotic
painkillers such as Percodan, Percocet or Codeine, so that other
medications can be substituted. Furthermore, rest assured that these
medications will not prompt you to act or speak foolishly during the
Your doctor will then examine and lubricate the rectal
opening to allow simple passage of the colonoscope. This will not be
painful, but is mildly uncomfortable for a few seconds. After the
colonoscope is properly positioned, your doctor gently guides the
scope through the colon, a process that takes approximately one-half
hour. To improve visualization, your doctor gently infuses air into
the colon. This may cause a sensation of abdominal fullness, but
should not be painful. In fact, many patients actually fall asleep
during the examination. As the test progresses, you may be asked to
change your position now and then to facilitate the passage of the
colonoscope through the colon. Here is a xray of the abdomen taken during a colonscopy
which demonstrates how far the scope travels into the colon all the
way to the right side of the colon.
passage of the colonoscope through the entire colon is impossible.
While this may be caused by a blockage, it is most often caused by
an extra "loop" of colon, adhesions from previous abdominal surgery,
or severe diverticulosis. In such cases, a limited examination may
be sufficient if the area of suspected abnormality has been
visualized. If not, a barium enema x-ray (lower GI) may also be
reveals any unusual condition such as inflammation, an ulcer, a
tumor, or a polyp, your doctor may photograph it. This photo
provides a permanent record for your medical chart and allows your
other doctors to see what is wrong. With the advent of
video-colonoscopy, it is now also possible to record the examination
on a videocassette for later review when necessary. To better
evaluate any areas of suspected abnormality, your doctor may take a
brushing or biopsy of the colon lining. A brushing involves the
passage of a tiny nylon brush through the center of the colonoscope.
The brush rubs against the lining of the colon and retrieves bits of
tissue for later analysis. To take a biopsy, the doctor passes a
metal forceps through the scope and snips off a tiny sample of colon
tissue for laboratory analysis. Both procedures are totally painless
for the patient. Be assured that the decision to take a biopsy does
not necessarily mean that your doctor suspects cancer. Biopsies of
the digestive tract are often taken to look for other problems such
as inflammation and ulcers.
The lining of the colon and rectum is normally smooth.
Sometimes, however, growths known as "colon polyps" appear on the
lining of the large intestine. Varying in size from pinheads to
growths several inches in diameter, polyps do not usually produce
any symptoms. Contrary to popular belief, polyps affect both men and
women equally. Most colon polyps are initially non-cancerous.
Nevertheless, as colon polyps continue to grow, they often develop
into cancer of the colon. Colon cancer has become quite common in
our society. In fact, nearly 1 in every 20 adult Americans will
develop colon cancer in their lifetime. Colon cancer is now the
leading cause of cancer deaths in nonsmokers. Only lung cancer takes
a greater toll. It is not widely known that colon cancer now kills
more women than breast cancer and more men than prostate cancer.
But, there is good news. Research has confirmed that the single best
prevention for colon cancer is the early detection and removal of
all colon polyps!!! In the past, colon polyps located beyond the
range of the proctoscope could only be removed by a major abdominal
operation. Of course, this procedure required about a week of
hospitalization and over a month of time lost from work for
recovery. Fortunately, medical technology now permits the simple
removal of most colon polyps. Should a small polyp be discovered
during your colonoscopy, the polyp can usually be removed
immediately. This prevents a potential colon cancer while
eliminating the need for major surgery.
The doctor removes
the polyp quite simply by placing a wire loop, or "snare,"
around the polyp's base and slowly tightening the loop. As the polyp
is severed, a mild electric current cauterizes the tissue to prevent
bleeding. There is no pain or any sensation as the polyp is removed.
Polyp removal can usually be done on an outpatient basis. Moreover,
since there is no incision, you may usually resume normal activity
the next day. Click here to see our Endoscopic Photo Atlas with some examples of what your doctor sees inside
your colon during colonoscopy.
After The Test
After an outpatient colonoscopy, you will be asked to
rest awhile in the recovery room. Your companion will be asked to
sit with you while the effects of the sedative begin to wear off.
Once you are more alert, the doctor will meet with you to discuss
the findings and any needed treatment. You will then be able to
return home with your companion's assistance. However, since you
will still be somewhat drowsy and uncoordinated, you will be taken
directly to your car in a wheelchair by the office personnel. It is
important that you go directly home; do not stop to eat along the
way. Although you may resume a regular diet at home, you should eat
lightly at first, and then gradually increase your intake of foods
as tolerated. Since air was placed in the colon during the
examination, you may experience the discomfort of mild "gas pains"
for several hours until the gas is expelled. Because of the
sedation's lingering effects, you should not drive, operate any
machinery, drink alcohol, or engage in any vigorous activity for the
remainder of the day. If the test is performed on an inpatient
basis, you will be taken back to your hospital bed for recovery. If
any specimens or polyps were extracted during the examination, the
doctor will contact both you and your personal physician when the
laboratory results become available. Further treatment or tests, if
necessary, will be discussed at that time.
Is This Test
medical procedure involves some degree of risk, complications rarely
occur in patients undergoing colonoscopy. With the advent of
flexible fiberoptic instruments, this test has become a safe and
simple method of directly examining the lower digestive tract. When
performed by a physician who is specially trained and experienced in
the procedure, the benefits of colonoscopy far exceed the risks.
Your doctor is a Gastroenterologist. In addition to
standard medical training, he has received special instruction in
diseases of the digestive system and has been thoroughly trained in
the safe and proper operation of the colonoscope. The combination of
his expertise and your cooperation should make this test as safe and
simple as possible. However, as with all medical procedures,
complications can occur.
risks are perforation of the colon (a tear through the bowel wall)
or bleeding. Although perforation generally requires surgery,
certain cases may be treated with antibiotics and intravenous
fluids. Bleeding may occur at the site of either a biopsy or polyp
removal. Typically minor in degree, such bleeding may stop on its
own or be controlled by cauterization. Occasionally, surgery is
necessary. Fortunately, both perforation of the colon and bleeding
are quite rare. Because bleeding may sometimes occur up to three
weeks after a colon polyp has been removed, you should not plan to
travel to any remote areas without medical access during this period
Other possible risks include drug reactions and
complications related to other diseases that you may have.
Consequently, you should inform your doctor of all allergic
tendencies and medical problems. Occasionally, the site of the
sedative injection may become inflamed and tender for a short time.
This is not serious. If inflammation occurs, applying warm
compresses to the area is usually helpful. While any of these
complications may occur, it is well to remember that each of them
occurs quite infrequently. Your doctor will be happy to discuss the
above risks with you further, especially with regard to your
particular situation and need for colonoscopy.
How About AIDS?
Due to the recent extensive coverage of AIDS by the
media, some patients have expressed the concern that they might, in
fact, contract AIDS through this examination. Be assured that this
is not the case. All our instruments are thoroughly cleaned and
undergo high-level disinfection after each use. Only techniques
known to kill all disease-causing bacteria and viruses, including
the hepatitis and AIDS virus, are employed in this process.
colonoscopy is a valuable tool for the diagnosis and treatment of
many diseases of the large intestine. Even when x-rays are normal,
the cause of symptoms such as rectal bleeding or change in bowel
habits may be determined by colonoscopy. It is also useful in the
diagnosis and follow-up care of patients with colitis. Through
colonoscopy, the detection and removal of colon polyps, and thus the
prevention of colon cancer, are made possible. Periodic colonoscopy
is a valuable tool in monitoring patients with previous polyps,
colon cancer, or a family history of colon cancer. In essence,
colonoscopy is a safe and worthwhile procedure that is extremely
well tolerated. If you have any questions about your need for
colonoscopy, do not hesitate to ask your doctor.