Colonoscopy

What is a colonoscopy?

A colonoscopy is a medical procedure used to examine the inside of the large intestine (colon) and rectum. It is performed using a specialized instrument called a colonoscope, which is a flexible tube with optical fibers and a video camera on top. During a colonoscopy, the patient typically lies on his side, and the colonoscope is carefully inserted through the anus and gradually advanced through the colon. With the help of the video camera at the tip of the colonoscope, the doctor can visually examine the interior of the colon, looking for any abnormalities such as polyps (benign growths), tumors, inflammation, or bleeding.

Why do I need a colonoscopy?

Colonoscopy is used for:
  1. Routine screening,
  2. Diagnosis of digestive disorders,
  3. Therapy of certain conditions of the large intestine.

Routine screening

Colonoscopy is used for detecting colorectal cancer. Routine screening involves regular preventive examinations even in individuals who have no symptoms or increased risk for a specific disease. Colorectal cancer is one of the most common cancers and often develops slowly over a long period without symptoms. Early detection of colorectal cancer is crucial for successful treatment and improved prognosis.

Colonoscopy is considered one of the most reliable methods for detecting colorectal cancer in its early stages. The general recommendation is that individuals over the age of 50, without specific risk factors, undergo colonoscopy as routine screening every 10 years. However, this recommendation may vary depending on the guidelines and recommendations of your country or healthcare institution.

What symptoms may indicate the need for a colonoscopy?

There are certain symptoms of gastrointestinal issues that may indicate the need for a colonoscopy. Here are a few symptoms that are often taken into consideration when considering a colonoscopy:
  • If you notice blood or dark stools (melena), it may be a sign of bleeding somewhere in the gastrointestinal tract, including the colon. Colonoscopy can help detect the source of bleeding and determine the cause.
  • If you observe a persistent change in your usual bowel habits, such as significant changes in stool consistency, color, or shape, it may be a sign of gastrointestinal problems. Colonoscopy can help examine the inside of the colon and determine the cause of the changes in bowel movements.
  • Persistent, intense, or continuous abdominal pain may require further evaluation. Colonoscopy can help examine the colon and identify potential causes of pain, such as inflammatory bowel disease, polyps, or tumors.
  • Unexplained weight loss can be a sign of abnormalities in the gastrointestinal tract, including the possibility of tumors. Colonoscopy can help assess the condition of the colon and rule out serious problems.

Evo nekoliko uobičajenih bolesti ili stanja koja se mogu dijagnostikovati kolonoskopijom:

  • Polyps are benign growths in the mucous membrane of the large intestine. Polyps can be precancerous or cancerous, so early detection and removal is crucial for the prevention of colon cancer.
  • Colorectal cancer, where the colon and rectum can be visually examined, and tissue samples (biopsies) can be taken for further analysis.
  • Inflammatory bowel diseases (such as ulcerative colitis or Crohn’s disease), where inflammation, scars, ulcers, and other characteristics of the colon’s lining can be assessed.
  • Diverticulosis are small bumps on the wall of the large intestine, which may be associated with diverticulosis or diverticulitis.
  • Gastrointestinal bleeding, where colonoscopy can help detect the source of bleeding, such as ulcers, angiodysplasia, or tumors.
  • Structural changes and narrowing’s of the colon, which can explain symptoms such as abdominal pain or changes in stool.

Therapeutic procedure for certain diseases of the gastrointestinal tract

Here are a few examples of how colonoscopy can be used as a therapeutic procedure for certain gastrointestinal diseases:

Polyp removal

Polyps, benign growths on the mucous membrane of the large intestine, can be detected during colonoscopy. If polyps are found, the doctor can immediately carry out their removal during the procedure. This is usually done using a polypectomy loop, which removes the polyp from the intestinal mucosa. Removing polyps can prevent the development of colon cancer.

Bleeding control

If there is bleeding from the intestines, the doctor may use a colonoscopy to identify the source of bleeding and perform appropriate therapeutic procedures. This may include the use of electrocoagulation (electric energy to stop bleeding), the use of injections of hemostatic agents, or the placement of clips to close the blood vessel.

Dilation of strictures

In certain conditions such as Crohn’s disease or strictures (narrowing) of the colon, colonoscopy can be used for dilation of the narrowing. This is achieved by placing a balloon at the tip of the colonoscope and gradually expanding the narrowed segment of the intestine.

Placement of stents

In cases where there is significant narrowing or obstruction of the colon, colonoscopy can be used to place a stent – a metal or plastic tube that is used to widen the narrowing and restore normal flow of food and fluids through the intestines.

Biopsy

During colonoscopy, the doctor may take tissue samples (biopsy) from suspicious areas of the mucous membrane of the large intestine. These samples are sent for further analysis in order to make an accurate diagnosis and plan appropriate treatment.

It is important to note that therapeutic procedures during colonoscopy are usually limited to minor interventions. In some cases, if more complex surgical intervention is required, it may be necessary to refer the patient to surgery.

How do I prepare for a colonoscopy?

The preparation for a colonoscopy plays a crucial role in ensuring a successful procedure. Here is a general guide on how to prepare for a colonoscopy:

Consultation with your doctor

First, consult with your doctor about the colonoscopy procedure. Discuss your health condition, allergies, current medications, and any past surgeries or health issues. Your doctor will provide you with detailed instructions and guidelines for preparation.

Adjustment of medications:

If you regularly take certain medications, it may be necessary to adjust their usage before the colonoscopy. If you have diabetes, consult with your doctor about adjusting your insulin dose prior to the procedure. If you take medications that prevent blood clotting (such as Aspirin, Plavix, Warfarin, Sintrom, Pradaxa, Xarelto, Eliquis, Fraxiparin), consult with your doctor about adjusting the medication dose before the procedure. Be sure to consult with your doctor on how to properly adjust your medications before a colonoscopy.

Laboratory diagnostics

You will need to bring the results of recent laboratory tests: blood count, biochemistry, PTT, PTT, INR not older than 7 days.

Special diet

Avoid consuming foods that contain seeds and are high in fiber (such as sesame seeds, grapes, muesli, tomatoes, peppers, whole grains, fresh fruits and vegetables, legumes, and nuts) a few days before the colonoscopy.

Day before the procedure

Plan your schedule as you will need to be close to a toilet on the day before the colonoscopy. During this time, you will only consume clear liquids such as clear soup, chicken broth, water, tea, apple juice without pulp, and colon cleansing preparations.

Colon cleansing preparations (e.g., Fortrans, Picoprep):

Your doctor will prescribe intestinal cleansing preparations to ensure that your bowels are completely empty before the colonoscopy. These preparations usually involve a powder solution that is dissolved in water and taken orally. They help cleanse the colon of fecal matter to ensure clear visualization during the procedure. It’s important to carefully follow your doctor’s instructions on how and when to use these preparations.

Transportation arrangements

Colonoscopy is usually performed under sedation or anesthesia, which can affect your ability to drive after the procedure. Therefore, it is important to arrange transportation home after a colonoscopy and not drive alone.

It is important to follow all guidelines and instructions given by your doctor to adequately prepare for the colonoscopy. If you have any questions or concerns about the preparation process, consult your doctor.

What happens on the day of the colonoscopy

Arrive at the hospital, clinic, or endoscopy center at the scheduled time. You may need to arrive earlier to complete administrative forms and go through the admission process.

The medical team will prepare you for the procedure. This may involve explaining the details of the procedure, signing consent forms, measuring vital signs (such as blood pressure and pulse), and establishing an intravenous line for fluid and medication administration during the procedure.

Colonoscopy is usually performed under sedation, which means you will be given medications to help you relax and feel calm. In some cases, general anesthesia may be administered. This will help you remain relaxed and not feel discomfort during the procedure.

Once you are prepared, the doctor will perform the colonoscopy. A flexible tube with a camera (colonoscope) will be inserted into your rectum and carefully guided through the colon. The doctor will carefully examine the inside of the colon and look for any abnormalities, polyps, or other signs of disease. If necessary, the doctor may take tissue samples (biopsy) or remove polyps during the procedure.

After the colonoscopy is completed, the doctor will carefully withdraw the colonoscope from the colon. During this time, the sedation will gradually wear off. You may be taken to a recovery area where the medical staff will monitor your recovery until you are fully awake.

Once you have recovered from the sedation, the doctor will meet with you to discuss the results of the colonoscopy, provide interpretation of the findings, and answer your questions. If biopsies or polyp removal were performed during the procedure, the doctor will explain the next steps in treatment and follow-up.

Do I stay awake during a colonoscopy?

During a colonoscopy, patients are usually given sedation to reduce discomfort and anxiety during the procedure. The level of sedation can vary from mild to moderate, depending on the patient’s needs and the decision of the doctor. In most cases, patients feel relaxed and calm during the colonoscopy. Sedation is typically achieved through the intravenous administration of medications such as benzodiazepines or opioids. These medications can induce a feeling of drowsiness, reduce discomfort, and provide amnesia during the procedure. Additionally, local anesthesia may be used to numb the rectal lining for further comfort.

Is colonoscopy a painful procedure?

Colonoscopy can cause some degree of discomfort, but most patients describe the procedure as tolerable and relatively painless due to the administration of sedation. The sedation used during a colonoscopy helps to reduce discomfort and anxiety. When inserting the colonoscope through the anus and navigating it through the large intestine, patients may feel mild pressure or cramps. However, the doctor will typically use lubrication and gradual advancement of the colonoscope to minimize discomfort.

It is important to note that patient experiences are individual, and the sensation of discomfort can vary from person to person. If you have a particularly low pain tolerance or are concerned about discomfort, it is advisable to discuss with your doctor prior to the procedure to consider possible options for pain relief or anxiety management.

Who performs a colonoscopy?

It is important that colonoscopy is performed by a qualified medical professional with experience in this procedure to ensure accurate diagnosis and appropriate patient care. Before undergoing a colonoscopy, it is always good to verify the qualifications and experience of the performer of the procedure.

Colonoscopy is typically performed by healthcare professionals from various specialized fields. Here are a few key healthcare providers who may perform colonoscopy:

A gastroenterologist is a physician specialized in diseases of the digestive system. They are trained to perform colonoscopy and are often the frontline healthcare providers involved in the diagnosis and treatment of colorectal diseases.

General Surgeon – a surgeon who specializes in surgical treatment of diseases of the digestive system. They may perform a colonoscopy as part of a diagnostic procedure or as preparation for surgery.

A certified medical technician or certified medical technician may be in charge of assisting a doctor in performing a colonoscopy. They assist in preparing the patient, handling equipment, and providing support during the procedure.

The anesthesiologist will be responsible for administering and monitoring anesthesia during a colonoscopy that can be performed with sedation or general anesthesia to provide comfort to the patient and prevent discomfort during the procedure.

It is important to note that every healthcare professional performing a colonoscopy must be trained and certified for this type of procedure. Ensure that the procedure is performed by qualified specialists.

How does the colonoscopy procedure work?

The colonoscopy procedure can be described step by step as follows:

Before the procedure, the doctor, gastroenterologist will give you detailed instructions on the preparation. This usually involves cleaning the intestines to remove fecal materials that could interfere with the examination. On the day of the procedure, you will come to a medical institution, where a colonoscopy will be performed. You will be placed in the reception room, where your medical history will be taken, vital signs will be measured, and an intravenous line will be set up to give fluids and medications during the procedure.

Prior to the actual procedure, you may receive sedative or anesthetic medication to help you relax and become comfortable. This will help ensure your comfort during the colonoscopy. You will be positioned on an examination table. Your back will be covered with a sterile cloak, and your legs will be placed in stirrups to provide access to the anus.

The doctor will carefully insert a flexible tube with a camera (colonoscope) through the anus and gently conduct it through the rectum and colon. The colonoscope has a light and a camera on top, which allows the doctor to examine the inside of the intestine. As the colonoscope progresses through the intestines, the doctor will carefully examine the mucous membranes, looking for polyps, tumors, inflammations, or other abnormalities.

During the procedure, biopsies (small tissue samples) may be taken, or polyps may be removed if necessary. When the doctor has finished examining the entire colon, the colonoscope will be carefully withdrawn. The procedure is typically considered complete once the colonoscope has been fully removed. After the procedure, you will be taken to a recovery room where medical staff will monitor your vital signs and allow time for you to awaken from sedation.

In some cases, you may need to remain under observation for a while longer before you are allowed to go home. The doctor will provide you with detailed information about the examination results, give instructions for your recovery, and potentially schedule a follow-up appointment or further consultations if needed.

How long does a colonoscopy take?

The duration of a colonoscopy can vary depending on several factors, but on average, a colonoscopy usually takes about 30 minutes to one hour. However, if polyps or other abnormalities requiring biopsy or removal are discovered during the examination, the procedure may take longer. An additional time interval may be needed to perform these procedures.

After the completion of the colonoscopy, you will be taken to a recovery room where you will be monitored by medical staff until you fully recover from sedation and are ready for discharge. Before scheduling a colonoscopy, your doctor will provide you with more specific information about the expected duration of the procedure, considering your specific circumstances and needs.

What happens after a colonoscopy?

After the completion of a colonoscopy, the following are some common activities and procedures:

After the procedure, you will be taken to a recovery area or room where you will have the opportunity to wake up from sedation and recover. Medical staff will monitor your vital signs and provide care and support.

Once you awaken and recover from sedation, the doctor will typically provide you with information about the results of the colonoscopy. If polyps or other abnormalities are discovered, the doctor will explain further steps, which may include biopsies, polyp removal, or additional tests.

You may be advised to avoid driving or making important decisions for the rest of the day due to lingering effects of sedation or possible post-procedure fatigue. It is also recommended to avoid heavy meals and alcohol during the first few hours after the colonoscopy.

If you have received sedation or anesthesia during the procedure, you need to wait for the effects to completely wear off before you are allowed to eat or drink. This usually takes several hours but can vary depending on individual factors.

Although complications are rare, your doctor will give you instructions on what to pay attention to after the procedure. This may include symptoms such as severe abdominal pain, bleeding from the anus, high fever or lack of bowel movements. If you notice any unusual symptoms, you should contact your doctor immediately.

If polyps or other irregularities were detected during the colonoscopy, the doctor will explain the plan of further care. This may include scheduling regular check-ups, monitoring, or eventual therapeutic procedures, if necessary.

How long does it take to recover from a colonoscopy?

Most people feel good enough to resume their usual activities within a few hours to a day after a colonoscopy. However, individual recovery can vary, and here are a few factors that influence it:
  • If you received sedation or anesthesia during the colonoscopy, you may feel drowsy or tired after the procedure. The effects of sedation typically last for a few hours, and full alertness may take some time. During this period, it is necessary to have someone drive you home and to avoid engaging in important activities that require concentration.
  • After a colonoscopy, your digestive system can recover from laxatives and preparations that you used before the procedure. It is important to follow the doctor’s instructions on nutrition after a colonoscopy. Usually, mild, light food is recommended in the first few hours or days after the procedure.
  • Some people may experience changes in bowel movements after a colonoscopy, such as temporary alterations in frequency, consistency, or color of the stool. This is usually temporary and should normalize within a few days.
  • Although complications are rare, it is important to monitor your condition after a colonoscopy. If you notice severe or unusual abdominal pain, rectal bleeding, high fever or any other worrisome symptoms, you should contact your doctor immediately.

What are the potential risks or complications of colonoscopy?

Colonoscopy is a relatively safe procedure, but like any medical intervention, there are certain potential risks and complications. Here are some of them:

Intestinal perforation

This is a rare complication, but there is a small chance of the colon being punctured (perforated) during a colonoscopy. This can occur due to mechanical pressure or if there is pre-existing damage to the colon. Perforation requires immediate medical intervention, and surgical repair may be necessary.

Bleeding

Colonoscopy can lead to minor bleeding, especially if polyps are removed or biopsies are taken. Usually, this is mild bleeding that stops spontaneously. In rare cases, intervention may be needed to stop the bleeding.

Reaction to anesthesia or sedation

If you are given sedation or anesthesia during a colonoscopy, there is a small chance that you may have a reaction to these medications. These may include allergic reactions, breathing problems, lowering blood pressure, or irregular heart rhythms. These complications are rare, but medical staff will be present to respond in a timely manner if they occur.

Infection

There is a small chance that an infection may occur, although colonoscopies are usually sterile procedures. Infection can occur in the event of bowel damage, which allows bacteria to enter the bloodstream. Sometimes there may also be an infection of the injection site of the sedation needle.
It is important to note that these risks are relatively rare and that most people recover without any complications.

When will I know the results of my colonoscopy?

The time required to obtain the results of the colonoscopy may vary depending on various factors, including the healthcare facility where the examination was performed, the speed of laboratory analysis of samples, and the time needed for image evaluation and reporting by the doctor.
In some cases, the doctor may provide preliminary results immediately after the completion of the colonoscopy, especially if visible polyps or other abnormalities were detected during the procedure. However, for more detailed analysis and confirmation of results, biopsy of tissue samples may be necessary, which can extend the time needed to obtain final results.
Typically, the results of a colonoscopy are available within a few days or weeks. Your doctor will usually schedule an appointment to discuss the results and provide further guidance regarding your health condition and any necessary treatment or monitoring.

What are abnormal results of colonoscopy?

Abnormal results of a colonoscopy indicate the presence of irregularities or changes in the large intestine:
  • Polyps are growths that can form on the inside of the intestine. They are often benign (non-cancerous), but some polyps can be pre-cancerous or cancerous. If polyps are detected during a colonoscopy, the doctor may remove them or take a tissue sample (biopsy) for further analysis.
  • A colonoscopy can detect the presence of tumors in the large intestine. Tumors can be benign or malignant (cancerous). If a tumor is detected, the doctor may take a tissue sample for a biopsy to determine the nature of the tumor.
  • A colonoscopy can reveal signs of inflammation or irritation in the colon. These findings may indicate the presence of inflammatory bowel diseases such as ulcerative colitis or Crohn’s disease.
  • A colonoscopy can reveal the presence of diverticula, small bumps in the wall of the colon. In most cases, diverticulosis is not serious, but in rare cases diverticula can become inflamed or cause complications.
  • A colonoscopy may identify the source of bleeding in the large intestine. This can be useful in diagnosing the cause of gastrointestinal bleeding.
It is important to note that abnormal colonoscopy findings are only preliminary results, and definitive diagnosis and further treatment are based on tissue sample analysis (biopsy) and additional tests. Your doctor will analyze and interpret the results of the colonoscopy and provide you with more detailed information about the detected irregularities and the further steps that will be needed.

Are there alternative methods for screening for colon cancer?

There are alternative screening methods for colon cancer that can be used as a replacement or complement to colonoscopy. These alternative tests for colon cancer screening include:

Fecal occult blood tests (FOBT)

These tests are used to detect traces of blood in the stool, which can be an indication of colon cancer. The fecal occult blood test (FOBT) uses chemical substances to detect traces of invisible bleeding. The fecal immunochemical test (FIT) uses antibodies to identify specific components of blood. A positive result requires further investigation, usually a colonoscopy.

Stool DNA test

These tests, such as the Cologuard test, detect genetic changes associated with colon cancer. Testing is done on stool samples. A positive result usually requires further examination by colonoscopy.

Virtual colonoscopy

This procedure uses X-ray imaging and computed tomography (CT) to provide detailed images of the colon. Virtual colonoscopy can detect polyps or other abnormalities. If something suspicious is identified, a conventional colonoscopy is usually required for further evaluation or removal.

Sigmoidoscopy

This is a similar procedure to colonoscopy, but it focuses only on the lower part of the colon (sigmoid colon). Sigmoidoscopy can detect polyps and other abnormalities in the lower part of the colon. However, for a complete examination of the colon, colonoscopy is usually required.

What are the benefits of colonoscopy for cancer screening compared to alternatives?

Colonoscopy has several advantages over alternatives for screening colorectal cancer. Here are a few key advantages of colonoscopy:

High detection accuracy

Colonoscopy is one of the most accurate methods for detecting polyps, tumors, and other abnormalities in the colon. During a colonoscopy, the doctor can directly examine the entire colon and take tissue samples (biopsies) or remove polyps. This allows more detailed evaluation and precise diagnosis.

The possibility of removing polyps at the same time

If polyps are detected during a colonoscopy, the doctor can remove them immediately. This reduces the risk of polyps developing into cancer and the need for additional procedures or surgeries to remove them.

Reliability and longer screening interval

If a colonoscopy shows normal results without the presence of polyps or other abnormalities, a follow-up colonoscopy is recommended after 10 years. This is a longer interval between screenings compared to alternative methods.

Possibility of therapy

Colonoscopy is used not only for diagnostics, but also for therapeutic purposes. During colonoscopy, the doctor may remove polyps, reduce, or stop bleeding, place stents or perform other interventions. This allows simultaneous diagnosis and treatment of the problem.

Assessment of the entire large intestine

Colonoscopy allows for a detailed examination of the entire colon, including the lower part, where polyps and tumors are often formed. This allows for a more comprehensive assessment of colon health and reduces the risk of missing abnormalities.

While colonoscopy has numerous advantages, it does require preparation and potential sedation during the procedure. Additionally, colonoscopy is a more invasive procedure compared to non-invasive alternatives such as fecal occult blood tests or stool DNA tests. Always consult with your doctor to determine the best screening method for you, considering your age, health condition, and other risk factors.

Take a look at the price of the colonoscopy in our price list.

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