Jump to navigation Jump to search Not to be confused with colostomy. US Navy 110405-N-KA543-028 Hospitalman Urian D. Colonoscopy is similar to sigmoidoscopy—the difference being related to which parts of the colon each can examine. Conditions that call for colonoscopies include gastrointestinal hemorrhage, unexplained changes in bowel habit and suspicion of malignancy. Fecal occult blood is a quick test which can be done to test for microscopic traces of blood in the stool. A positive test is almost always an indication to do a colonoscopy. Colonoscopy is one of the colorectal cancer screening tests available to people in the US who are over 50 years of age. Subsequent rescreenings are then scheduled based on the initial results found, with a five- or ten-year recall being common for colonoscopies that produce normal results. People with a family history of colon cancer are often first screened during their teenage years. Among people who have had an initial colonoscopy that found no polyps, the risk of developing colorectal cancer within five years is extremely low.
Medical societies recommend a screening colonoscopy every 10 years beginning at age 50 for adults without increased risk for colorectal cancer. Research shows that the risk of cancer is low for 10 years if a high-quality colonoscopy does not detect cancer, so tests for this purpose are indicated every ten years. Colonoscopy screening prevents approximately two thirds of the deaths due to colorectal cancers on the left side of the colon, and is not associated with a significant reduction in deaths from right-sided disease. Since polyps often take 10 to 15 years to transform into cancer, in someone at average risk of colorectal cancer, guidelines recommend 10 years after a normal screening colonoscopy before the next colonoscopy. This interval does not apply to people at high risk of colorectal cancer, or to those who experience symptoms of colorectal cancer. About 1 in 200 people who undergo a colonoscopy experience a serious complication.
Perforation of the colon occurs in about 1 in 2000 procedures, bleeding in 2. 6 per 1000, and death in 3 per 100,000. Therefore, in some low-risk populations, screening in the absence of symptoms would not outweigh the risks of the procedure. For example, the odds of developing colorectal cancer between the ages of 20 and 40 are only 1 in 1250. The rate of complications varies with the practitioner and institution performing the procedure, as well as a function of other variables. The most serious complication generally is the gastrointestinal perforation, which is life-threatening and in most cases requires immediate major surgery for repair.
Bleeding complications may be treated immediately during the procedure by cauterization via the instrument. Delayed bleeding may also occur at the site of polyp removal up to a week after the procedure and a repeat procedure can then be performed to treat the bleeding site. Dehydration caused by the laxatives that are usually administered during the bowel preparation for colonoscopy also may occur. Therefore, patients must drink large amounts of fluids during the days of colonoscopy preparation to prevent dehydration. Virtual colonoscopies carry risks that are associated with radiation exposure. Colonoscopy preparation and colonoscopy procedure can cause inflammation of the bowels and diarrhea or bowel obstruction. One of the most serious complications that may arise after colonoscopy is the postpolypectomy syndrome. Bowel infections are a potential colonoscopy risk, although very rare.
The colon is not a sterile environment as many bacteria live in the colon to ensure the well-functioning of the bowel and therefore the risk of infections is very low. Minor colonoscopy risks may include nausea, vomiting or allergies to the sedatives that are used. If medication is given intravenously, the vein may become irritated. On very rare occasions, intracolonic explosion may occur. A meticulous bowel preparation is the key to prevent this complication. The colon must be free of solid matter for the test to be performed properly. For one to three days, the patient is required to follow a low fiber or clear-liquid only diet.
A typical procedure regimen then would be as follows: in the morning of the day before the procedure, a 238 g bottle of polyethylene glycol powder should be poured into 64 oz. Since the goal of the preparation is to clear the colon of solid matter, the patient should plan to spend the day at home in comfortable surroundings with ready access to toilet facilities. The patient may also want to have at hand moist towelettes or a bidet for cleaning the anus. The patient may be asked to skip aspirin and aspirin-like products such as salicylate, ibuprofen, and similar medications for up to ten days before the procedure to avoid the risk of bleeding if a polypectomy is performed during the procedure. A blood test may be performed before the procedure. Some hospitals and clinics have begun to utilize a technique used in colon hydrotherapy as an alternative to the standard preparation methods described above.
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