Colonoscopy

Colonoscopy Device

An instrument called a colonoscope is used during a colonoscopy. It is a long, flexible tube with a tiny camera and light on the end to examine the inside of the colon (large intestine).

By adjusting the various controls on the colonoscope, your doctor can safely guide the instrument to carefully examine the inside lining of the digestive system or the upper or lower gastrointestinal tract. 

Other instruments can be inserted through the colonoscope, which allows various therapeutic procedures to be carried out during a Colonoscopy procedure. 

Such therapeutic procedures may include 

• Biopsy - taking tissue samples (biopsies) and
• Polypectomy - removal of polyps (abnormal growths).
• Tissue resection - removal of abnormal growths or early colorectal cancer with advanced techniques like Endoscopic Mucosal Resection (EMR) or Endoscopic Submucosal Dissection (ESD)
• Cauterisation - to treat bleeding
• Dilation - to treat strictures

Polyps or growths are removed during a colonoscopy and can be sent for diagnostic testing by a pathology lab.

Who is Suitable for Colonoscopy?

Colonoscopy is recommended for adults aged 45 years and above with an average risk of colon cancer. However, people with a family history of colon cancer, inflammatory bowel disease, primary sclerosing cholangitis or other colon-related diseases may need to start screening earlier. There is concern regarding the increasing trend of colon cancers diagnosed at a young age. Hence recent bowel cancer guidelines have reduced the screening age to 45 years from 50 years. Your doctor will determine the frequency of your colonoscopies based on your medical history and risk factors.

What are the Benefits of Colonoscopy?

The benefits of colonoscopy are many, including early detection of colon cancer, which can lead to higher survival rates. Colonoscopy can also detect and remove precancerous polyps, preventing them from becoming cancerous. Additionally, a colonoscopy can identify and diagnose other colon-related diseases, such as inflammatory bowel disease or bleeding.

What are the Types of Colonoscopy?

There are three main types of colonoscopy: diagnostic, therapeutic and screening colonoscopies. 

• A diagnostic colonoscopy is performed when symptoms, such as abdominal pain, rectal bleeding, or a change in bowel habits, are present. 
• A therapeutic colonoscopy is performed to treat an underlying problem, such as bleeding or abnormal growths, including polyps and early colon cancers.
• A screening colonoscopy is performed on individuals who have no symptoms but are at risk of developing colon cancer.

Alternative Options to Colonoscopy

While colonoscopy is the gold standard for colon cancer screening, alternative options are available. These include faecal occult blood tests (FOBT), faecal immunochemical tests (FIT), and virtual colonoscopies. However, these alternative options may not be as accurate as colonoscopy and may require follow-up testing.

Irregularities During Colonoscopy

Occasionally, narrowing of the bowel or other diseases may prevent the instrument from being inserted through the entire colon length. 

If your doctor identifies any irregularities during the colonoscopy, they may recommend further testing or treatment, depending on the type and severity of the irregularity. 

The irregularity may sometimes require additional testing, such as a CT scan or MRI. Your doctor will discuss any findings and recommend appropriate treatment based on your circumstances.

How Long Does a Colonoscopy Take?

The procedure typically takes around 30 minutes to an hour to complete, depending on the length of your colon and whether any polyps or other abnormalities are detected. 

Consent Forms for Colonoscopy

Because of the risk of cancer, it is recommended that all polyps found be removed at the time of colonoscopy. 

Due to sedation, it will not be possible to discuss the removal now; therefore, if you have any questions regarding polyp removal, please discuss this before the procedure. 

For the colonoscopy to be performed, you must sign a consent form on the day of the procedure.

How Do I Prepare for a Colonoscopy?

• Bowel preparation: You must follow a special diet and take bowel preparation medication before your procedure. Printed instructions will be provided at the time of your booking, or click here for instructions. 
• Fasting: Stop eating the day before the procedure and stop drinking clear liquids approximately 2 hours before the procedure. The hospital will contact you one working day before your procedure to advise you of your fasting time. 
• Medications: You will be instructed to stop your blood-thinning and diabetes medications.

During Colonoscopy Procedure

• During a colonoscopy, you will lie on your left side on an examination table. Your doctor will administer a sedative to help you relax and reduce any discomfort. 
• Once you're sedated, your doctor will insert a colonoscopy, a long, flexible tube with a tiny camera and light on the end, through your rectum and into your colon. The camera allows your doctor to view the colon's inner lining on a monitor.
• As the colonoscope is advanced through your colon, your doctor will examine the lining for any abnormalities, such as polyps or lesions. If any polyps are found, they can be removed during the procedure. Your doctor will use small instruments to remove the polyps or take a biopsy of any abnormal tissue for further analysis.

Once the procedure is finished, you'll be monitored briefly to ensure the sedative wears off and you're feeling well enough to go home.

After Your Colonoscopy

After your colonoscopy, carefully following your doctor's aftercare instructions is essential to ensure a smooth and successful recovery. Here are some common aftercare instructions you may receive:

• Rest: You should rest for the remainder of the day following your colonoscopy to allow the sedative to wear off fully. Arrange for someone to drive you home after the procedure.
• Diet: You may be instructed to follow a specific diet for a few days after colonoscopy. Your doctor may recommend avoiding certain foods, such as those high in fibre or difficult to digest, to reduce discomfort and promote healing.
• Medications: Your doctor may advise you to stop taking certain medications shortly after the procedure, especially blood thinners. You should also avoid taking nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin or ibuprofen, for a few days following your colonoscopy.
• Hydration: Drink plenty of fluids to help flush out your system and prevent dehydration. Avoid alcohol and caffeine for at least 24 hours following your colonoscopy.
• Physical activity: Avoid strenuous physical activity for at least 24 hours after the colonoscopy. Depending on the results, your doctor may recommend you take it easy for a few days following the procedure.
• Follow-up: You'll need to follow up with your doctor to discuss the results of your colonoscopy and any further treatment, such as removing polyps. Your doctor may also schedule a follow-up colonoscopy based on your risk factors and the procedure results.

Risks and Complications with Colonoscopy

For inspection of the bowel alone, complications of colonoscopy are very uncommon. Most surveys report complications of 1:1000 examinations or less.

As with any medical procedure, there are risks associated with colonoscopy. However, relatively low risks occur in a small percentage of cases. It's essential to understand these risks before undergoing the procedure. Some common risks of colonoscopy include:

• Intervention during colonoscopy like polypectomy may cause bleeding. If bleeding occurs, it's typically minor and stops on its own. However, in rare cases, delayed bleeding may need to be treated.
• A perforation occurs when the colonoscope punctures the wall of the colon. This is a rare but potentially serious complication that may require surgery to repair.
• A colonoscopy can introduce bacteria into the colon, possibly leading to an infection. This is a rare complication but can be serious if it occurs.
• Some people may experience an adverse reaction to the sedative used during the procedure, such as breathing problems or an allergic reaction.
• Other rare risks of colonoscopy include injury to the spleen, adverse reactions to medications used during the procedure, abnormal heart rhythms, and complications related to underlying health conditions.

Discussing the potential risks of colonoscopy with your doctor before the procedure is essential. Your doctor will evaluate your health history and risk factors to determine if a colonoscopy is best for you. The benefits of colonoscopy generally outweigh the risks, but it's important to understand the potential complications before the procedure. Dr Wang will discuss measures to reduce the risks of colonoscopy.

What if Colonoscopy is Delayed?

Delaying a colonoscopy should not be taken lightly, as early detection is crucial in preventing and treating colon cancer. However, if your colonoscopy is delayed, it is important to discuss your options with your doctor to ensure you receive the appropriate screening and care.