Colonoscopy or Polypectomy

What is a Colonoscopy?
A colonoscope is a long, flexible tube that is about the thickness of a finger. It is inserted through the rectum into the large intestine (colon) and allows the physician to carefully examine the lining of the colon. Abnormalities such as polyps can be found and even removed during a colonoscopy.

If the doctor sees a suspicious area or needs to evaluate an area of inflammation in greater detail, he or she can pass an instrument through the colonoscope and take a sample of tissue (a biopsy) for examination in the laboratory. Biopsies are taken for many reasons and do not necessarily mean that cancer is suspected. A small brush can be introduced as well to collect cells from an abnormal area for examination in the laboratory (a form of “pap test” or “cytology”).

What is a polypectomy?
During the course of the examination a polyp may be found. Polyps are abnormal growths of tissue, which vary in size from a tiny dot to several inches. If your doctor feels that removal of the polyp is indicated, he or she  will pass a wire loop (snare) through the colonoscope and sever the attachment of the polyp to the intestinal wall by means of an electrical cautery. If additional polyps are detected, they may be removed as well. You should feel no pain during removal of the polyp. Polyps are usually removed because they can cause rectal bleeding or may contain cancer. Although the majority of polyps are benign (noncancerous), a small percentage may contain an area of cancer in them or may develop into cancer. Removal of colon polyps, therefore, is an important means of prevention and cure of colon cancer, which is a leading form of cancer in the United States.

What preparation is required?
For the best possible examination, the colon must be completely empty of waste material. A low residue diet must be followed two days before the colonoscopy. Also, a bowel cleansing prep must be used the day before the colonoscopy. Do not take aspirin, drugs containing aspirin or iron tablets at least one week prior to the procedure. If you are taking any type of “blood thinner” or diabetes medicine, please let the nurse know. You may take all other medications unless otherwise instructed by your physician.

Be sure to let your doctor or nurse know if you are allergic to any drugs. You must have someone accompany you to your appointment who can drive you home after the procedure. You will be sedated for the colonoscopy and will not be able to drive for 8 hours. Even though you may not feel tired, your judgment and reflexes may not be normal.

What should I expect during the procedure?
Anesthesia personnel will give you medication through a vein to make you feel relaxed and sleepy. Propofol is the anesthesia drug recommended for endoscopy and is used for sedating patients in The Endoscopy Center. With this medicine, a colonoscopy is essentially painless, and you will recall little if anything of your procedure. 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.

The procedure is usually well tolerated and rarely causes pain. Patients are asleep during the examination.

In rare cases, passage of the colonoscope through the entire colon cannot be achieved. In this case, the patient may be sent to a radiology office to have an X-ray to check the intestine beyond the area through which the scope could not pass.

What happens after the colonoscopy?
You will be kept in the recovery area of The Endoscopy Center 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 to help the doctor see the colon better.

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 or nurse may instruct you to be on a limited diet before returning to your regular diet.

Are there any complications of colonoscopy and polypectomy?
Colonoscopy and polypectomy are safe and are associated with minimal risk when performed by physicians who have been specially trained and are experienced in these endoscopic procedures. However, complications, although very infrequent, can occur.

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 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 that may remain for several weeks to several months but goes away eventually.

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.

Why is colonoscopy necessary?
Colonoscopy is a valuable tool for the diagnosis and treatment of many diseases of the large intestine. Abnormalities suspected by X-ray can be confirmed and studied in detail. Even when X-rays are negative, the cause of symptoms such as rectal bleeding or change in bowel habits may be found by colonoscopy. It is useful for the diagnosis and follow-up of patients with inflammatory bowel disease as well.

Colonoscopy’s greatest impact is probably in its contribution to the control of colon cancer by polyp removal. Before colonoscopy became available, major abdominal surgery was the only way to remove colon polyps to determine if they were benign or malignant. Now, most polyps can be removed easily and safely without surgery. Periodic colonoscopy is a valuable tool for follow-up of patients with previous polyps, colon cancer and family history of colon cancer.

Colonoscopy is a safe and extremely worthwhile procedure that is very well tolerated. Your doctor’s decision to perform this procedure was based upon his assessment of your particular problem. If you have any questions about your need for colonoscopy, do not hesitate to discuss them with your doctor. If you have questions regarding the cost of the procedure, method of billing and insurance issues, please talk to one of our billing staff. Our common goal is your good health and it can only be achieved through mutual trust, respect and understanding.

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.