Colonoscopy Health Article

Preparation

The physician should be notified if the patient has allergies to any medications or anesthetics, bleeding problems, or is pregnant. The doctor should also be informed of all the medications that the person is currently taking and if the patient has had a barium enema x-ray examination recently. If the patient has had heart valves replaced, the doctor should be informed so that appropriate antibiotics can be administered to prevent infection. The risks are explained to the patient beforehand, and the patient is asked to sign a consent form.

The colon must be thoroughly cleansed before performing colonoscopy. Hence, for two or more days before the procedure, considerable preparation is necessary to clear the colon of all stool. The patient is asked to refrain from eating any solid food for 24 to 48 hours before the test. Only clear liquid such as juices, broth, and Jello are allowed. Red or purple juices should be avoided, since they can cause coloring of the colon that may be misinterpreted during the colonoscopy. The patient is advised to drink plenty of water to avoid dehydration. A day or two before the colonoscopy, the patient is prescribed liquid, tablet, and/or suppository laxatives by the physician. In addition, commercial enemas may be prescribed. The patient is given specific instructions on how and when to use the laxatives and/or enemas.

On the morning of the colonoscopy, the patient is not to eat or drink anything. Unless otherwise instructed by the physician, the patient should continue to take all current medications. However, vitamins with iron, iron supplements, or iron preparations should be discontinued for a few weeks prior to the colonoscopy because iron residues in the colon can inhibit viewing during the procedure. These preparatory procedures are extremely important to ensure a thoroughly clean colon for examination.

After the procedure, the patient is kept under observation until the medications' effects wear off. The patient has to be driven home and can generally resume a normal diet and usual activities unless otherwise instructed. The patient is advised to drink lots of fluids to replace those lost by laxatives and fasting.

For a few hours after the procedure, the patient may feel groggy. There may be some abdominal cramping and considerable amount of gas may be passed. If a biopsy was performed or a polyp was removed, there may be small amounts of blood in the stool for a few days. If the patient experiences severe abdominal pain or has persistent and heavy bleeding, it should be brought to the physician's attention immediately.

For patients with abnormal results, such as polyps, the gastroenterologist will recommend another colonoscopy, usually in another year or so.

Complications

The procedure is virtually free of any complications and risks. Rarely (two in 1000 cases) a perforation (a hole) may occur in the intestinal wall. Heavy bleeding due to the removal of the polyp or from the biopsy site occurs infrequently (one in 1000 cases). Some patients may have adverse reactions to the sedatives administered during the colonoscopy, but severe reactions are very rare. Infections due to a colonoscopy are also extremely rare. Patients with artificial or abnormal heart valves are usually given antibiotics before and after the procedure to prevent an infection.

Results

The results are normal if the lining of the colon is a pale reddish pink and there are no masses that appear abnormal in the lining.

Abnormal results indicate polyps or other suspicious masses in the lining of the intestine. Polyps can be removed during the procedure, and tissue samples can be biopsied. If cancerous cells are detected in the tissue samples, then a diagnosis of colon cancer is made. A pathologist analyzes the tumor cells further to estimate the tumor's aggressiveness and the extent of the disease. This is crucial before deciding on the mode of treatment for the disease. Abnormal findings could also be due to inflammatory bowel diseases such as ulcerative colitis or Crohn's disease. A condition called diverticulosis, which causes many small fingerlike pouches to protrude from the colon wall, may also contribute to an abnormal result in the colonoscopy.