Colonoscopy is the endoscopic examination of the large intestine. During colonoscopy, real-time imaging of the mucous membranes of the rectum, the sigmoid intestine, the colon, and the border between the colon and the small intestine is performed. A video-endoscope is used during the examination. The device is a 130-150 cm long, flexible, 1 cm wide tube, with a controllable end housing a small camera. The transmitted image is observed by the examining physician.
The examination requires 3-4 days of dietary (low-fiber diet) and drug (laxatives) preparation. Usually, the day before the examination a soup with nothing added is recommended for lunch, followed by taking the laxative. This may be any product of the proper strength, currently the most frequently applied agent is castor oil (which may disturb visualization due to its oily nature and often causes nausea and vomiting), flavored solutions on prescription, and phospho soda solutions. Large volume fluid intake (water, tea) is recommended afterwards to completely clear out the bowels.
The examination is usually performed in sedation, with the administration of a sedative-painkiller injection. After the examination, short observation and rest is necessary, and driving is prohibited. Blood count, measurement of bleeding and haemostasis parameters (blood sample) is necessary before therapeutic intervention, and any anticoagulant (Syncumar, Marfarin) and anti-platelet (Aspirin, Astrix) treatments are suspended.
Indications of colonoscopy are the following: abdominal pain, bloody stool, long-lasting constipation, diarrhea, changes in bowel habits, suspected inflammatory bowel disease, or as part of screening for colon cancer. Therapeutic interventions can also be performed besides diagnostics during the examination (polyp removal, stopping bleeding, taking biopsy specimens for histology examination).
During examination, the patient lies on his left side with legs pulled up. At the physician’s order, the patient, with the help of the assistant, may need to turn on his back, maybe right side or rarely, on his stomach. The device is coated with a lubricant, and carefully introduced into the rectum. The intestinal lumen is dilated by blowing air, or occasionally, water into the bowels. The duration of the examination is 10-40 minutes.
During examination, the patient may experience the sensation to defecate provoked by the device, bloating due to the air blown in, abdominal cramps and pain caused by expansion of the peritoneum covering the bowels. These symptoms are more frequent in patients who have adhesions after previous abdominal surgery.
Drugs for preparation may cause dizziness, nausea, vomiting, or hiccoughing. The patient receives the results immediately after the examination, but if a biopsy sample was taken, the histology report will be completed in 1-2 weeks. If a therapeutic intervention was performed, hospital observation may be needed on the basis of the risks.
Complications of the examination include bowel perforation and bleeding at the sight of polyp removal. The latter can usually be stopped by endoscopy but the former requires surgery.
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