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I am Dr. Mark Mellow, Medical Director of INTEGRIS’ Digestive Health Center. I understand you are scheduled to have a colonoscopy. I want to review several issues about which you may have questions or concerns. |
What is a Colonoscopy?
The colon is a long hollow tube measuring four to five foot long. It starts in the right lower portion of the abdomen, called the cecum, and ends at the rectum. Its function is to store unabsorbed food products prior to their elimination. A colonoscope is a long flexible tube with a camera and a light on the end of the scope. By turning a set of dials your doctor can guide the scope thru your colon. The transmitted picture is of high quality and allows your doctor to have a very good look at the colon. That way areas of inflammation can be identified and samples, called biopsies, can be obtained. Similarly growths, called polyps, can be identified, biopsied or removed. Typically a colonoscopy lasts 20 to 40 minutes. You will be given a sedative medication to relax. Most patients will be essentially asleep for the test. Medications given are not general anesthetics, however, so you are able to breathe on your own. One important point about the sedation: Once you wake up, you may think, that you are just fine, and you are able drive home. Well, you're not. Studies show that your driving skills are quite impaired for hours after sedation. Therefore, you must have a responsible person who can take you home after your procedure.
Who performs Colonoscopies?
I am proud to say that at INTEGRIS Baptist Medical Center all colonoscopies are performed by gastroenterologists or surgeons trained in the technique. That is not always the case at other hospitals. You might ask, "Why this is important?" Several studies have shown that the ability to perform a complete examination of the colon improves with experience and training. While the picture of the colon we have shown you makes it look like a smooth road from beginning to end, in reality, some people have colons that make extreme twists and turns and some have elongated colons. Therefore, it is not surprising that an experienced colonoscopist can navigate the colon better than the untrained or inexperienced colonoscopist. Fully trained gastroenterologists can examine the colon completely in over 95 percent of their cases. In addition, other studies have shown that ability to detect polyps, the precancerous growths that can develop in the lining of the colon, increases with training and experience. In fact in a recent report, patients that had colonoscopies performed by non-gastroenterologists were two times more likely to have a colon cancer found in a subsequent exam than those who had their exam by a gastroenterologist. Additionally, complications from a colonoscopy are less frequent when performed by a gastroenterologist.
Why am I having a Colonoscopy?
We have learned that early detection of colon polyps and colon cancers will help prevent death from colon cancer. That’s why regularly scheduled exams called screening exams are important. Most often colonoscopies are performed as a routine screening test similar to a mammogram, pap test, or prostate test, to detect an early and hopefully curable cancer or detect a precancerous growth. In the hospital however most colonoscopies are done to identify the cause of a specific symptom such as diarrhea, passage of blood in the bowels, change in bowel pattern, or unexplained abdominal pain. Your doctor will explain to you the specific reason your colonoscopy is being performed. Fluid samples may be taken from the colon to evaluate the cause of diarrhea, samples may be obtained from the lining of the bowel, called biopsies. They identify a cause of inflammation or some other abnormality of the colon lining, such as a polyp.
How do I prepare for a Colonoscopy?
I will now describe what is typically the worst part of the procedure called the colon prep; the laxative cleaning out of the colon. It is however an extremely necessary part of the colonoscopy procedure. Remember if the doctor cannot see it, he or she cannot remove it and even worse will not even know it's there! Additionally, it is more dangerous to perform a colonoscopy in a poorly prepared colon. Imagine driving a car in a rain and sleet storm! Without good visualization of the colon lining it is easier to damage the colon. So please make every effort to complete your laxative prep. You may need to take an anti-nausea medication. Sometimes just slowing down the prep process a half hour or so, waiting for the sensation of fullness or nausea to pass will do the trick. Just because you are passing liquid it does not mean the entire colon is empty of solids or cloudy fluids. Various laxative preparations have been extensively tested and have been proven effective if directions are followed. Preparation for a colon exam typically starts with 24 hours of a clear liquid diet. Includes black coffee, tea, Sprite, and Jell-O. Avoid anything RED, as red fluid might be misidentified as blood in your colon. You might ask if consuming a liquid diet or not eating for 24 hours can clean my colon out? The answer unfortunately is NO. Only strong laxatives result in an appropriate clean out. You might ask can I just get cleaned out with enemas? The answer unfortunately is NO as well. Enemas clean out the lower portion of the colon but colons are four to five feet long. In patients who are otherwise healthy there are a wide variety of laxatives that can be used. However, in many patients who have concurrent medical conditions such as kidney disease or severe heart disease, preparation options are more limited. These are the more common preps used in colonoscopy. Your physician will explain to you the particular clean out he or she has ordered.
What can I expect during and after the Colonoscopy?
Your doctor and nursing staff will do their best to keep you comfortable during the colonoscopy. As mentioned above, colonoscopies typically last 20 to 40 minutes. You will most likely receive a sedative to keep you comfortable or asleep during the exam. The medicine is given into your IV just before the exam. Your doctor watches a screen like a regular TV, while performing the exam. After the procedure patients may feel drowsy, gassy, bloated, or even have some pain. Air is placed in the colon during the exam to help see the bowel lining well. Expelling this gas will help. Severe pain however needs to be reported to the doctor as soon as possible if in doubt, go to the emergency room. You will be examined by the staff there and your physician will be contacted. Tell the emergency room staff that you have just had a colonoscopy, and you are having severe pain, it could be a tear disruption in the lining of your colon called a perforation. If you are passing more than a small amount of blood, contact your physician. This will be especially true if you are feeling weak, dizzy or light headed at the time you are passing blood from your rectum.
When will I be informed about my Colonoscopy results?
The sedative given during the procedure will often cause amnesia. In other words, you may not remember events occurring after the procedure. If relatives accompany you to the Colonoscopy they can be informed of the findings. As mentioned before, specimens can be removed during the procedure. The specimens are sent to the pathology laboratory and results of the biopsies generally require a few days before a report is available.
What is a Polyp? How are they treated?
A polyp is a growth in the lining of the bowel. Polyps can be small or large, single or multiple. Polyps can be benign in other words not cancerous or malignant in other words cancerous. Most polyps are benign. However, if left inside your colon they can become cancerous. That is why polyps are removed when they are discovered. Before colonoscopy was developed, major abdominal surgery was required to remove polyps. Now a colonoscopy allows a much safer and easier way to remove the large majority of polyps. Small polyps can be removed by biopsy it is like snipping away with a tweezer. Larger polyps are removed by a wire loop that is passed through the scope. The wire loop lassos the polyp and an electric current is passed through the wire to cut the polyp off and seal off blood vessels. Typically we try and remove polyps totally. However, sometimes it is not possible. Sometimes very large polyps especially flat to the colon surface cannot be safely removed from the colon. Typically in this circumstance your doctor would consult a surgeon and a decision would be made as to whether removal of the growth by an actual operation would be appropriate. Sometime a flat growth can be destroyed by a special cautery device or laser beam applied through the scope. In these special circumstances where the polyp cannot be removed safely through the scope, your doctor and a surgeon will explain your options to you.
What are the possible complications?
Overall a Colonoscopy is a safe and accurate procedure. But, as with any medical or surgical procedure there are risks and complications. Your doctor will explain them to you. In general I will describe the three most unwanted things that can occur related to a colonoscopy.
- Colon perforation- this is a disruption or tear in the colon wall and almost always necessitates an operation to repair the tear. Sometimes the tear is actually recognized during the examination. Other times perforations occur occur up to 24 hours after the procedure. This is called a delayed perforation. Perforations can occur in patients with severe diverticular disease. Diverticuli are little pouches in the bowel wall. The affected area may become stiff and narrow and making it hard to pass the scope. Perforation also can occur after polyp removal as you are typically removing a polyp with a cautery or burning device. Fortunately perforations are not common. They occur in less than 1 in a 1000 procedures. Again, studies show that colon perforations are less likely when a procedure is being performed by a trained physician.
- Bleeding- Bleeding can occur after removing a polyp frequency of bleeding after polyp removal is approx 1 in 200. This typically occurs where polyps are located in the innermost part of your colon, where the colon wall is the thinnest. Therefore, there is more likelihood that there is a blood vessel present just beneath the surface. Bleeding after polyp removal often stops on its own but sometimes requires repeat colon exam to apply cautery to the area. On rare occasion surgical treatment is required. Because of associated medical problems some patients require medications such as Coumadin or Aspirin or other anti-platelet agents. Since they were prescribed to prevent events such as a stroke or heart attack, your doctor will make the decision regarding when to resume the blood thinners.
- Failure to detect polyps or other growths in your colon- Because many polyps are flat and there are many folds in the colon, polyps that are less than ½ inch in size, approx 1 cm or less, go undetected approx 10% of the time. However, going to a trained physician and having a clean colon can lessen the chances of missing colon polyps or other growths.
I want to stress that, while the colon prep is no fun, most patients who undergo a colonoscopy by a well trained physician do not feel that it was an overall unpleasant experience. The staff and I at the Digestive Health Center hope that you have a safe and uneventful colonoscopy.
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