Colonoscopy :

ANATOMY OF THE COLON

The colon is the last part of the digestive system and is approximately 5 feet long in adults. It is comprised of four sections:

• Ascending colon
• Transverse colon
• Descending colon
• Sigmoid colon

The primary function of the colon is to absorb water and nutrients and pass waste through the rectum in the form of stools.

INDICATIONS OF COLONOSCOPY PROCEDURE

Colonoscopy is a versatile medical procedure that can be used for various reasons such as prevention, diagnosis, and treatment. Below are some of the indications of colonoscopy procedure:

• Identifying the cause of symptoms such as bleeding per rectum, abnormal bowel movements (diarrhea, constipation, incontinence), unexplained weight loss, persistent severe abdominal pain, and other intestinal problems.
• Routine screening for colon and rectum cancer. According to the American Cancer Society, colonoscopy should be performed as a regular screening test starting at the age of 45 years, as the incidence of developing colon and rectum cancer increases with age.
• Diagnosing other intestinal abnormalities such as colorectal polyps or cancer, diverticulitis or diverticulosis, chronic colitis (such as ulcerative colitis or Crohn's disease), ulcers or perforations in the large intestine, large bowel obstructions, and more.
• Obtaining biopsy samples from the polyps.
• Treating inflammatory bowel diseases, identifying and treating acute bleeding sites in the large intestine, decompressing the colon in the case of sigmoid volvulus and Ogilvie syndrome, excising and ablating lesions, treating lower GI bleeding, dilating colonic stenosis, removing foreign bodies, and more.
• Post-resection surveillance for colonic cancer.

CONTRAINDICATIONS OF COLONOSCOPY

A colonoscopy is considered to be one of the safest procedures. However, there are a few contraindications for the colonoscopy procedure, which include:

• Colonoscopy is contraindicated during pregnancy since the chances of miscarriage are high
• In case of suspected colonic perforations
• During toxic megacolon
• In case of fulminant colitis or severe IBD (inflammatory bowel disease) with ulceration
• Uncooperative patients
• Clinically unstable patients
• Inadequate bowel preparation
• Peritonism

STEPS FOR THE COLONOSCOPY PROCEDURE

The colonoscopy procedure involves the following steps:

Before the procedure, the doctor will give you certain instructions, which include:

• Not coming alone : You are advised to not come alone on the day of the procedure.
• Diet Plan : You are advised to avoid foods that have a lot of fiber such as raw vegetables, whole grains, fruits, nuts, etc. for several days before the procedure. The doctor will advise you to stay on a liquid diet before the day of the procedure. You should not have any solid food at least 12 hours before the procedure. You are allowed to take clear liquids such as water, tender coconut, etc. The doctor advises you to avoid red-and-purple color drinks or gelatins a day before the procedure.
• Laxatives : Preparation of the bowel is one of the major aspects of the colonoscopy procedure. In order to empty the entire bowel, the doctor will advise you to take laxatives such as enema, powder laxatives, pills, or liquid, the night before the procedure so that there is no stool impaction in the colon during the time of the procedure.
• Medications : The doctor will advise you to stop taking medications for a few days before the procedure. These include blood thinners such as warfarin, anticoagulants such as dabigatran or rivaroxaban, clopidogrel, diabetic medications, multivitamin tablets containing iron, etc.

• The colonoscopy procedure is often performed as a daycare procedure. You are advised to be admitted on the day of the procedure. You will be taken to the procedure room, where the anesthetist will give you sedation through the intravenous root. This will ensure that you do not feel discomfort or pain during the procedure.
• During the procedure, a long, thin, flexible tube along with a camera and light is inserted through the anus into the rectum, sigmoid colon, and the colon. Carbon dioxide is inflated inside the bowel loops in order to enlarge them. The doctor will examine the entire large intestine to look for any signs of abnormalities such as polyps, inflammation of the colon, abnormal bleeding in the intestine, abnormal growth in the intestine, etc. The doctor might take a few biopsy samples in case of growth or polyps in the intestine and send them for a histopathological examination. Once the procedure is done, the doctor will pull the tube out through the same route in the opposite direction while re-examining the colon.

• You will be shifted to the recovery room and kept under observation for a few hours after the procedure. You are advised to not have anything for 2-3 hours after the procedure. You can go home on the same day of the procedure. You are advised to not drive by yourself due to the sedation after the procedure. You should have a regular follow-up with the doctor after the procedure.
• You might feel slight bloating, nausea, or pain in the abdomen after the procedure.

COMPLICATIONS ASSOCIATED WITH COLONOSCOPY

The complications that are associated with colonoscopy include:

• Continuous bleeding after the polyp removal or post-biopsy procedure
• Infections.
• Bowel irritation due to the procedure
• Perforation of the intestine during the procedure
• Abdominal distension
• Splenic rupture
• Postpolypectomy coagulation syndrome
• Side effects associated with sedation
• Nausea, vomiting, or rectal irritation after the procedure

FREQUENTLY ASKED QUESTIONS

The colonoscopy procedure is usually performed under sedation. As a result, the patient generally does not feel any pain during the procedure. However, the patient may experience mild bloating in the abdomen due to the inflation of carbon dioxide during the procedure.

Who performs the colonoscopy procedure?

The colonoscopy procedure is often performed by a gastroenterologist or a coloproctology surgeon.

What medications should the patient stop taking a few days before the procedure?

The doctor will advise the patient to stop taking several medications before the procedure, including vitamins containing iron, blood thinners, diabetic medications, anticoagulants, smoking, and Clopidogrel.

Are there different types of colonoscopy prep kits available?

The colonoscopy prep kits can be divided into two types. These include:

• Saline-based formulas (NaP) - Saline-based laxatives typically include sodium phosphate (NaP) as a primary osmotic agent.
• Polymer-based formulas (PEG) - The most commonly used prep formula that uses a polymer-based laxative known as polyethylene glycol 3350, which is used before the procedure.

What are the alternative tests available for colonoscopy?

There are various other tests available for colonoscopy, including CT colonoscopy, CT abdomen, double-balloon enteroscopy, sigmoidoscopy, fecal occult blood test, and colon capsule endoscopy.

How long does the colonoscopy procedure take?

A colonoscopy procedure often takes about 15-45 minutes

What is the cost of a colonoscopy procedure?

The cost of a colonoscopy procedure typically varies between Rs 5000-10,000 in India. However, if the procedure is used for a therapeutic purpose, then its cost will vary.

What are the benefits of a colonoscopy procedure?

The benefits of a colonoscopy procedure include:

• Helps in the diagnosis of various intestinal disorders
• Can be used in treating various conditions
• Cost-effective
• Painless and early recovery
• Early detection of colorectal cancer
• Can be performed as a daycare procedure on an out-patient basis
• Improved quality of life.