Colonoscopy (biopsy and polyp removal) & Screening Guidelines

Colonoscopy (biopsy and polyp removal):

Colonoscopy is the visual examination of the large intestine (colon) using a lighted, flexible fiberoptic or video endoscope. The colon begins in the right-lower abdomen and looks like a big question mark as it moves up and around the abdomen, ending in the rectum. It is 5 to 6 feet long. The colon has a number of functions including withdrawing water from the liquid stool that enters it so that a formed stool is produced.

Equipment

The flexible colonoscope is a remarkable piece of equipment that can be directed and moved around the many bends in the colon. Colonoscopes now come in two types. The original purely fiberoptic instrument has a flexible bundle of glass fibers that collects the lighted image at one end and transfers the image to the eye piece. The newer video endoscopes use a tiny, optically sensitive computer chip at the end. Electronic signals are then transmitted up the scope to a computer which displays the image on a large video screen. An open channel in these scopes allows other instruments to be passed through in order to perform biopsies, remove polyps, or inject solutions.

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Reasons for the Exam

There are many types of problems that can occur in the colon. A patient's medical history, physical exam, laboratory tests and x-rays can provide information useful in making a diagnosis. However, directly viewing the inside of the colon by colonoscopy is usually the best exam. Colonoscopy is used for:

Colon cancer - a serious but highly curable malignancy
Polyps - fleshy tumors which usually are the forerunners of colon cancer
Colitis (Ulcerative or Crohn's) - chronic, recurrent inflammation of the colon
Diverticulosis and Diverticulitis - pockets along the intestinal wall that develop over time and can become infected
Bleeding lesions - bleeding may occur from different points in the colon
Abdominal symptoms, such as pain or discomfort, particularly if associated with weight loss or anemia
Abnormal barium x-ray exam
Chronic diarrhea, constipation, or a change in bowel habits
Anemia

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Preparation

To obtain the full benefits of the exam, the colon must be clean and free of stool. The patient will receive instructions on how to do this. It involves drinking a solution which flushes the colon clean or taking laxatives and enemas. Usually the patient drinks only clear liquids and eats no food for the day before the exam. The physician will advise the patient regarding the use of regular medications during that time.

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Procedure

Colonoscopy is usually performed on an outpatient basis. The patient is mildly sedated, the endoscope is inserted through the anus and moved gently around the bends of the colon. If a polyp is encountered, a thin wire snare is used to lasso it. Electrocautery (electrical heat) is applied to painlessly remove the ployp. Other tests can be performed during colonoscopy, including biopsy to obtain a small tissue specimen for microscopic analysis.

The procedure takes 15 to 30 minutes and is seldom remembered by the sedated patient. A recovery area is available to monitor vital signs until the patient is fully awake. It is normal to experience mild cramping or abdominal pressure following the exam. This usually subsides in an hour or so.

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Results

After the exam, the physician explains the findings to the patient and family. If the effects of the sedatives are prolonged, the physician may suggest an appointment at a later date. If a biopsy has been performed or a polyp removed, the results of further analysis may not be available for three to seven days.

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Benefits

A colonoscopy is performed to identify and/or correct a problem in the colon. The test enables a diagnosis to be made and specific treatment can be given. If a polyp is found during the exam, it can be removed at that time, eliminating the need for a major operation later. If a bleeding site is identified, treatment can be administered directly and accurately to stop the bleeding. Other treatments can be given through the endoscope when necessary.

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Alternatives

Alternative tests to colonoscopy include a barium enema or other types of x-ray exams that outline the colon and allow a diagnosis to be made. Study of the stools and blood can provide indirect information about a colon condition. These exams, however, do not allow direct viewing of the colon, removal of polyps, or the completion of biopsies.

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Side Effects and Risks

Bloating and distension typically occur for about an hour after the exam until the air is expelled. Serious risks with colonoscopy, however, are very uncommon. One such risk is excessive bleeding, especially with the removal of a large polyp. In rare instances a tear in the lining of the colon can occur. These complications may require hospitalization and, rarely, surgery. Quite uncommonly a diagnostic error or oversight may occur.

Due to the mild sedation, someone must be available to drive the patient home. The driver may leave, but must be available by mobile phone. The patient should not drive or operate machinery following the exam.

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Summary

Colonoscopy is an outpatient exam that is performed with the patient lightly sedated. The procedure provides significant information used to diagnose a colon condition and determine which specific treatment should be given. In certain cases, therapy can be administered directly through the endoscope. Serious complications rarely occur from colonoscopy. The physician can answer any questions the patient may have.

This material is provided by Medical Schedule, Inc and does not cover all information and is not intended as a substitute for professional medical care. Some of this material may have been adapted from materials provided both online and in print by other reputable medical resources.

Screening Guidelines


Risk	Procedure	Onset	Frequency
1. Asymptomatic low risk	Digital and fecal occult blood	Age 40	Yearly
	Sigmoidoscopy	Age 50	3-5 years
2. Asymptomatic high risk	Fecal occult blood	Age 35	Yearly
	Colonoscopy or barium enema and sigmoidoscopy	Age 40	3-5 years
3. Familial adenomatous polyposis	Sigmoidoscopy	Age 10	Yearly until adenomatous age 40; then polyposis follow asymptom atic high- risk guidelines
4. A. Ulcerative colitis (pancolitis)	Colonoscopy	Disease years 7 and 8	Every 2 years until 20 years of disease; then annually
B.Ulcerative left-sided colitis (or Crohn's colitis)	Colonoscopy	Disease year 15	Every 2 years
5. Symptomatic patient	Barium enema orcolonoscopy (preferred if bleeding, occult blood, or melena)	--
6. A. Polyp surveillance (adenoma)	Colonoscopy	--	Yearly until colon cleared; then every 3-5 years
B. Hyperplastic	Colonoscopy	--	Repeat colonoscopy in one year; then revert to asymptom atic low risk if colon cleared
Colorectal cancer
Surveillance After Resection
A. If colonoscopy Colonoscopy or barium or barium enema enema cleared colon preoperatively		--	One year post-operatively; then every 3 years if colon cleared
B. If colon not cleared pre-operatively by barium enema or colonoscopy	Colonoscopy or barium enema	--	Within 6 months; then every 3 years if colon cleared

Surgical Treatment of Colorectal Cancer

The most effective treatment of colorectal cancer is surgical removal. In the special case of small cancers found in polyps, removal of the polyp may be the only treatment needed; however, this type of treatment is recommended only after careful review of the pathology and with surgical consultation.

Abdominal Surgery

Most colorectal cancers are removed by an abdominal operation. The vast majority are done without the need for a colostomy. Surgery is the primary treatment for colorectal cancer because when it is performed for cure, it completely removes the primary cancer and allows for the staging, or evaluation, of the risks for cancer spread.

Even if the cancer has spread, surgery will provide the best opportunity to relieve uncomfortable symptoms and prevent either bowel obstruction or bowel bleeding. Sections of the colon and rectum are removed along with the lymph glands that are associated with the particular part of the bowel.

Team Approach

Although surgery is the primary therapy for colorectal cancer, a team approach is essential for continuing care. Each colorectal cancer patient has their case discussed at a weekly meeting. At this meeting, colorectal surgeons, medical oncologists, radiation oncologists, pathologists, gastroenterologists and clinical nurse specialists review the treatment plans for each patient. These plans include a review of the most recent techniques and clinical studies that may benefit the patient.

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