What is screening colonoscopy?
Screening colonoscopy is an endoscopic procedure using a long, flexible tube about the thickness of a finger to view the entire colon. It is performed by a gastroenterologist trained and skilled in the procedure to carefully examine the lining of the colon and for the detection and removal of precancerous colon polyps if present. The test is performed under sedation to essentially eliminate any discomfort.
What preparation is required?
Thorough cleansing of the colon so the gastroenterologist can obtain clear views of the lining of the colon is essential. Click here (L-A: will need to have this) for the PDF that details the prep. If you have questions about the preparation, please contact us.
You will need someone to take you home since you will not be allowed to drive after the procedure. Even though you may not feel tired, your judgment and reflexes may not be normal.
What should you expect during screening colonoscopy?
Your doctor and anesthesia personnel will give you a medication through a vein to make you relaxed and sleepy. Propofol is recommended and is used for anesthesia in our centers. With this medicine, screening colonoscopy is essentially painless.
While you are lying in a comfortable position, the colonoscope is inserted into the rectum and gradually advanced through the colon while the lining is examined thoroughly. The colonoscope is then slowly withdrawn while the intestine is again carefully examined. In rare cases, passage of the colonoscope through the entire colon cannot be achieved.
What happens after screening colonoscopy?
You will be kept in the recovery area until most of the effects of the medication have worn off. You may feel bloated and gassy right after the procedure because of the air that was introduced into the colon.
As soon as the procedure has been completed, you may resume your usual diet, unless other instructions are given. If a polyp has been removed, your doctor may limit your diet for a time before returning to your regular diet. It is generally advisable to avoid heavy lifting and exercise for several days after a polypectomy.
Are there complications from screening colonoscopy?
Screening Colonoscopy is safe and is associated with minimal risk when performed by physicians who have been specially trained and are experienced in this endoscopic procedure.
One major possible complication is perforation, in which a tear through the wall may allow leakage of intestinal fluids. It may be managed with antibiotics and intravenous fluids, although surgery is usually required.
Bleeding may occur from the site of a biopsy or polyp removal. It is usually minor and stops on its own or can be controlled by cauterization (application of electrical current) through the colonoscope. Rarely, transfusions or surgery may be required.
Localized irritation of the vein can occur at the site of medication injection. A tender lump develops which may remain for several weeks to several months but goes away eventually.
Although uncommon during colonoscopy, aspiration (breathing in) of stomach contents that come up through the esophagus can occur. This could lead to pneumonia and the need for hospitalization.
Other risks include drug reactions and complications from unrelated diseases such as heart attack or stroke. Death is extremely rare but remains a remote possibility.
What are the reasons for doing screening colonoscopy?
Colon cancer is the second-leading cause of cancer death in the United States, second only to lung cancer. In most cases, colon cancer can be prevented. It affects males and females equally. Almost every colon cancer develops in benign colon polyps. We know that it usually takes at least several years for a polyp to become malignant. During this period of time, or “window of opportunity,” if a polyp is found and removed, colon cancer may be prevented.
Approximately 25% of the population over the age of 50 will harbor pre-malignant polyps (adenomas). Unfortunately, most of these polyps produce no symptoms. If risk factors are present (such as family history of colon polyps or colon cancer), the rate is significantly higher. Although it has been estimated that only a small percentage of pre-malignant polyps will actually become malignant, there is currently no way to determine which polyps will and which won’t progress to cancer.
Current national guidelines for colorectal cancer screening recommend screening for everyone beginning at age 50. Many physicians are now beginning to advise that a full colon exam, such as screening colonoscopy, be used as the principal screening test in the average-risk individual and that this be carried out at designated intervals (for example, every five to 10 years).
Are there alternatives to screening colonoscopy?
Although most authorities agree that screening colonoscopy is the most accurate screening procedure to detect colon polyps and colon cancer, other options for screening are available. The American Cancer Society and other organizations recognize alternatives that include individually or as a combination of stool exams for blood, flexible sigmoidoscopy and air contrast barium enemas at various intervals. The recently promoted CT scan (virtual colonoscopy) is also an alternative procedure. However, it is important to understand that if an abnormality is found by any alternative method, colonoscopy will likely be recommended for further treatment.
General Insurance Information
A screening colonoscopy is now recommended and paid for by Medicare for “average risk” individuals without symptoms every 10 years.
Other insurance companies are gradually adding coverage for screening colonoscopy but, unfortunately, a few do not cover the procedure. Therefore, the asymptomatic individual (who has a 15-25% risk of having polyps) may be responsible themselves for payment, depending on the insurance company’s policies. Also, patients who have large co-payment insurance policies may be responsible for payment. For these reasons, we require the patient to sign a waiver, which places him/her as being financially responsible.
If polyps are found during the screening colonoscopy, we would plan to remove them at the time (the reason for having the exam). In this situation, we would submit bills to the insurance company with the diagnosis of “colon polyp.” Medicare and many insurers, but not all, will then cover the procedure. If a polyp is removed, you will be billed an additional fee. Also, you can expect a bill for the pathology analysis.
The physicians at GIA are happy to provide this service for interested individuals without preliminary consultation. On the other hand, we would welcome a chance to meet with patients in the office to discuss the procedure in more detail.
Colonoscopy enjoys an excellent safety record in our facility, but there is a very small potential for complications. We expect the patient to carefully review the prepared handout on the procedure before it is scheduled. The colon preparation is a tedious, but very important, part of the test. The avoidance of aspirin or any blood thinners a week before the procedure is also important. Because of the use of intravenous anesthetic agents during the procedure, arrangements must be made for the patient to be picked up at the end of the exam. If polyps are removed, there is a slight chance of delayed bleeding, so we request that the exam be scheduled at least two weeks before contemplated travel.
Your doctor’s decision to perform this procedure was based upon his/her assessment of your particular problem. If you have any questions about the procedure or your need for a screening colonoscopy, do not hesitate to discuss them with your gastroenterologist. Both of you share a common goal – your good health – and it can only be achieved through mutual trust, respect and understanding.
To schedule a screening colonoscopy, contact our office at (865) 588-5121. Ask for the Scheduling Department and request an appointment for screening colonoscopy. Our staff will be pleased to help coordinate the scheduling of the procedure and will provide you with reading material and detailed information regarding preparation for the procedure.
This information is provided as an educational service of Gastrointestinal Associates, P.C. The content is limited and is not a substitute for professional medical care.