It is an examination of the lower part of the digestive system which allows to investigate the entire large bowel and, through the ileocecal valve, the distal part of the small bowel .
The doctor uses a flexible endoscope with a camera transmitting images to a high resolution monitor to examine the whole distal part of the digestive system.
Preparation for the examination, i.e. cleaning out the intestines, is extremely important. The quality of the procedure depends on how well the patient is prepared – if the lining of the intestine is clean, polyps and other pathologies are significantly easier to spot.
An endoscopist can not only diagnose, but also remove small polypous lesions and obtain tissue samples if a neoplastic disease is suspected.
Indications for colonoscopy
Colonoscopy is indicated mainly when the patient experiences the so-called “alarm symptoms” – when the clinical image can be associated with a malignant growth. These include: blood in the stool, change in bowel habit, abdominal pain, loss of weight. If such symptoms appear, the patient should see a doctor immediately to qualify for colonoscopy. Colonoscopy is, however, an invasive procedure and should not be performed too often, only in patients with aforementioned clinical image or as a prophylactic examination according to the guidelines below.
A prophylactic colonoscopy should be performed in every patient aged above 45 years, and in case of positive family history of colorectal cancer, above the age of 35.
If the patient was properly prepared and the examination revealed no pathologies, the next colonoscopy should be done after 10 years.
Colonoscopy can assure the patient, that within the next few years, he will not develop cancer. If polyps are diagnosed, the doctor removes them during the same procedure, meaning that a diagnostic colonoscopy can turn to a therapeutic one.
In our clinic we perform these examinations:
- private (without a referral letter), with a possibility for the procedure to be conducted in general anaesthesia supervised by an anaesthesiologist
- free of charge (within NFZ National Healthcare) with a referral letter from a family physician
- free of charge as a part of the Polish Colorectal Cancer Screening Program (first examination, age 50-65 years)
The examinations are performed by experienced specialists using the cutting-edge quality equipment. It ensures highest safety and quality of the procedures. It is important that colonoscopy does not always have to be associated with pain and discomfort. In our clinic we are trying to change the way endoscopic examinations are perceived in the society.
Preparation
Proper preparation is crucial for good analysis of the walls of the intestine. If the patient is not well prepared, the examination may not succeed.
Presently we have a number of different pharmacological measures to properly prepare the patient for the examination (cleaning out the bowel). It is, however, required that the patient follows the administration guidelines according to the scheduled time of the examination.
We do not have to (as it used to be a earlier) starve or fast for weeks to properly prepare for the examination. It is sufficient to follow a low fiber diet in the last couple of days before the procedure (avoid whole grain bread, fruit seeds and other elements, which pass slowly through the digestive system and could obstruct the view during colonoscopy).
The patient is allowed to eat normally until afternoon the day before the examination. If the examination is scheduled for morning hours, the first dose of the medication should be taken in the evening followed by large amounts of liquid. It can be water, tea or clear juice without pulp. The second dose should be taken in the morning hours, so that the patient stops drinking any fluids approximately 2 hours prior to the examination. If the procedure is scheduled for afternoon hours, the medication should be taken on the day of the examination in two split doses.
Colonoscopy can be also performed with sedation, where an anaesthesiologist is present during the procedure. Patients are given sedatives to achieve the so-called “twilight anaesthesia”.
Sigmoidoscopy
This examination enables the physician to look at the end part of the large intestine and allows to see otherwise invisible abnormal growths or ulcers.
The flexible tube is inserted into the rectum and then guided to the sigmoid and the descending colon. Sigmoidoscopy can be performed without previous preparation. Shortly before the examination the patient is given an enema to wash out the intestine.
Procedure
The patient lies on his or her side and an endoscope is passed through the rectum into the colon. The moment of introducing the flexible tube might cause discomfort and even pain, especially when the doctor has to pass through tight turns or insufflate the bowel with air to properly examine its walls. The course of the examination depends on the patient’s previous medical history and his or her build. If the patient had any abdominal surgery in the past, he or she might have abdominal adhesions, which increase the discomfort during the examination. If polyps are found, they will be immediately removed using a diathermic loop. Every polyp or growth removed during the procedure will be sent to a pathology lab for microscopic evaluation. Polypectomy is painless and it allows us to treat the patient and prevent developing colorectal cancer.
Complications
The procedure is safe when conducted on a high-class equipment by experienced specialists. It is, however, and invasive examination, meaning there is a small risk of complications. One of them is perforation, that is puncturing the wall of the intestine, which occurs more often in elderly patients with diverticula. Colonoscopy in such patients requires extreme care, proficiency and experience.
Another complication is bleeding, especially after removing polyps, which can be treated by using special haemostatic clips. These complications are rare, but both the physician and the patient must not forget them and be aware of the risks.
