Colonoscopy: All you need to know (indications, procedure, follow up)
What is a colonoscopy?
A colonoscopy is the endoscopic procedure performed by a gastroenterologist who checks the inner surface of the large bowel (also called the colon).
Colonoscopy is the examination of choice for the detection of colorectal polyps (i.e., harmless clumps of cells that form on the inner lining of the colon which need to be removed so as not to lead to bowel cancer) and colorectal cancer. Colonoscopy is also performed for any of the symptoms mentioned below in this article.
Screening colonoscopy is performed in asymptomatic healthy individuals over 45 years of age and up to 75 years of age, unless polyps were previously found. Screening colonoscopy is a preventive method against colorectal cancer, since when symptoms, such as presence of blood in stools, do occur, this would mean that valuable time has already been lost for a radical treatment.
Colonoscopy is preferred to any other imaging technique (computed tomography, barium enema, etc.) since it offers the advantage of biopsies and endoscopic removal of polyps, if found.
When should I plan a screening colonoscopy for colorectal cancer prevention?
The American Cancer Society has recently issued a recommendation that both men and women at average risk of colorectal cancer start regular screening at the age of 45 and continue screening throughout the age of 75. For individuals aged 76-85, the decision to be screened should be based on a person’s preferences, life expectancy, overall health, and prior screening history. Individuals over 85 should no longer get colorectal cancer screening.
Which are the indications for a colonoscopy other than screening for colorectal cancer?
Colonoscopy is distinguished as diagnostic (to detect a cause of a symptom) and therapeutic (to cure a disease). Symptoms that justify undergoing a diagnostic colonoscopy are:
- Blood in stools
- A change in the bowel habits (diarrhea or constipation) of a recent onset
- Abdominal pain or rectal pain
- Suspicious findings in the large intestine in a random imaging study (computed tomography or CT, magnetic resonance imaging or MRI, PET, etc.)
- A history of bowel disease (ulcerative colitis, colorectal cancer, previous removal of polyps, etc.)
Can I undergo an esophagogastroduodenoscopy (EGD) and a colonoscopy at the same time?
Gastroscopy and colonoscopy are two different endoscopic procedures of the upper and lower gastrointestinal tract, respectively. However, if there are indications that warrant investigation both of the upper and the lower digestive system, EGD and colonoscopy can be performed during the same session.
Esophagogastroduodenoscopy is usually performed first and then follows colonoscopy, while the patient is still sleeping after having received sedation. Performing gastroscopy and colonoscopy together saves time and hassle for the patient.
What does the bowel prep before the colonoscopy involve?
The bowel needs to be cleaned from feces before the colonoscopy. You will need to drink some liters of a special solution to evacuate your bowel the previous day of the colonoscopy. Dr. Chris Zavos who will perform your colonoscopy will give you detailed advice on how to achieve optimal bowel cleansing and how to tackle feeling uncomfortable when you receive the bowel prep solution.
Please note that 3-4 days prior to the colonoscopy you need to follow a special diet. The diet involves consuming low-fiber foods that are easy to digest and leave your digestive system quickly.
Feel free to consume:
- White bread, pasta, potatoes, and rice
- Lean meat, chicken, or fish
- Coffee or tea without milk
Please do NOT consume:
- Seeds, nuts, popcorn, bread or buns with sesame
- Fatty foods (pork meat, pastry etc.)
- Whole grains
- Vegetables and fruits
- Dairy products (milk, cheese, yoghurt)
If you are taking vitamins, oral iron or other supplements you should stop them for at least 5-7 days before the colonoscopy.
The day prior to the colonoscopy you are allowed to consume only clear liquids.
Dr. Zavos will instruct you whether and when you should stop taking any prescription medicines you use regularly, and any over-the-counter anti-inflammatory or blood thinner meds you may use. Aspirin and anticoagulants such as Plavix or Sintrom should be discontinued for at least 5 days and be replaced by low molecular weight heparin subcutaneous injections.
Also, make sure that you mention any known allergies to medications or special conditions such as prolapse of mitral valve or metallic heart valve prosthesis.
How is colonoscopy performed? Does colonoscopy hurt?
Colonoscopy is performed under deep sedation (midazolam and propofol) meaning that you will not experience any pain during the procedure since you will be sleeping. Dr. Zavos will insert a flexible instrument through your anus and will examine the inner lining of your bowel up until the cecum (the right side of your abdomen). Also, a part of the small bowel called terminal ileum will also be examined if indicated.
Biopsies will be obtained if necessary, which is a safe procedure that does not cause any pain nor has it any risks for you. Biopsies will be examined under the microscope by a specialist pathologist and results will be out within a couple of days.
If polyps are found, they will be removed with a procedure called polypectomy. Polypectomy has a small risk of bleeding or perforation, but this can be managed endoscopically most of the times.
The duration of the colonoscopy is usually 30-45 minutes, but can last longer if polyps need to be removed.
What follows after the colonoscopy?
Dr. Zavos will explain the findings and hand you the report of the colonoscopy along with a set of pictures documenting the findings. You will be allowed to eat and drink only after you are fully conscious.
You can go home within one hour after you are fully conscious, but you will not be allowed to drive a car for several hours after the examination.
What are the risks of a colonoscopy and when should I call back?
Call back Dr. Zavos if you experience severe symptoms such as:
- Abdominal pain, more intense than usual gas in the gut
- Severely bloated and stiff abdomen
- Passage of blood in stools after polyp removal
Gastroenterologist Dr. Chris Zavos performs upper and lower gastrointestinal endoscopies at a private hospital in Thessaloniki Greece. Endoscopies are performed under deep sedation with propofol and midazolam completely painless. All endoscopes are sterilized based on international standards.
How much does a colonoscopy cost?
You may call or email Dr. Zavos to learn the cost of a gastroscopy and colonoscopy in Thessaloniki Greece. Contact Dr. Zavos at: firstname.lastname@example.org or +30-6976596988.
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