Colonoscopy

Colonoscopy

A method of examining the state and structure of the rectum and colon, which uses an endoscopic device - an elastic thin probe (1.2 cm in diameter), carefully promoted through the anus into the lumen of the colon. In addition to real-time evaluation of the examined intestinal tissues, the doctor additionally assesses it by video images got during the procedure.

How colonoscopy is performed

Colonoscopy lasts 15-60 minutes, in average. The patient lays on the left side or on the back while the endoscope is examinating the intestinal. Examination of the tissues are carried out both when promoting the probe and when taking it out. It is felt distention and pressure in the abdomen. 

Usually, patients tolerate the colonoscopy satisfactorily, sometimes the pain is sensable. For the patient comfort and better thoroughness of the procedure, the examination can be carried out in a medicated sleep.

In case of patient's unproper preparation to the procedure, or because of peculiarity of the colon, or due to postoperative state of a patient there are no opportunity to make examination thoroughly, the doctor prescribes non-invasive examination methods like computer tomography, or irrigoscopy – x-ray examination with barium enema of the colon. 

If during the examination there are signs of the mucosal pathology development, a doctor performs the biopsy - the procedure of taking a tissue sample for further histological analysis under a microscope. This analysis confirms or cancels the malignant diagnosis. The biopsy accurately determines the nature of pathological changes in the tissue and ensures to start timely an effective treatment. If a biopsy is made during endoscopy, the doctor does not necessarily think about cancer, every change in the mucous membrane state must be examined by histological analysis. Also during a colonoscopy, the doctor can identify the source of bleeding and stop it at once without additional surgery.

If polyps are found, they are removed immediately during the colonoscopy procedure. This significantly improves the patient's condition and also eliminates the need for further surgery. However, sometimes it is necessary to repeat colonoscopy in order to examine the mucous membrane at the place of polyp removal, if those were large or there were several polyps removed. Such removals of rectal and colon polyps are an important measure of bowel cancer prevention!

What happens after a colonoscopy

Immediately after the end of the colonoscopy, the doctor tells the patient about the results of the examination and issues a conclusion. If a biopsy was performed during the colonoscopy, the patient receives the final diagnosis after 6-10 days.

The patient stays under doctors observation until the symptoms of bloating and distension in the abdomen, which occurs during the injection of air during the procedure, are eliminated. The patient can go to the toilet, after the gases leave, the well-being improves. If the colonoscopy was performed under total intravenous anesthesia, the patient remains under observation for some time. If necessary, the doctor prescribes repeated examinations in each specific case.

It is possible to take food and return to the usual rhythm of life on the same day.

Possible complications after colonoscopy

Colonoscopy is generally safe, but as with any endoscopic examination, complications may occur. This can happen when biopsy or removal of polyps and can manifested by bleeding or rupture of the intestinal wall. Elimination of the complications consequences requires a surgery which, usually, is performed immediately.

In all cases, when a sharp pain in the abdomen, blooding from the intestine, fever appears after a colonoscopy, it is necessary to immediately consult a doctor or call an ambulance.

Chromocolonoscopy (colonoscopy with contrast)

Chromocolonoscopy is a type of colonoscopy with the coloration of the mucous membrane for better visualization of its changes. Depending on the interaction of mucosal cells with the contrast agent, the doctor assesses the nature of pathological changes, the depth and its extention. This is the most accurate and qualified diagnosis of the malignant development at the earliest and asymptomatic manifestations of the disease. In «Manufactura» clinic we use the mode of narrow-spectral imaging (NBI) during a chromocolonoscopy which givess the detailed imaging.

Virtual colonoscopy

It is a type of computer tomography that allows doctors to get the same information as in the case of a regular colonoscopy. Unlike the usual, virtual colonoscopy is a non-invasive diagnostic method and is performed using a computer tomography.

Indications for the colonoscopy: 

• Colonoscopy is prescribed in case of complaints or clinical signs related to colon diseases:
• the presence of pus, mucus and traces of blood in feces;
• chronic diarrhea or constipation;
• flatulence, and pain along the colon;
• unknown etiology of anemia;
• polyps in upper part of the gastrointestinal tract, detected during esophagogastroduodenoscopy (gastroscopy), as well as polyps detected during rectomanoscopy, require revision of the colon;
• for tumors detected by other diagnostic methods (CT, MRI), colonoscopy is prescribed for biopsy and visualization of the lesion;
• colonoscopy can be prescribed as an additional examination in case of enlarged hemorrhoids or anal fissures, as the they often mask colon tumors with bleeding;
• pathology of adjacent organs (endometriosis), tumors of the pelvic organs;
• before gynecological surgery;
• colonoscopy is also indicated for patients from the risk group: those with a family tumor history (familial polyposis); patients with non-specific inflammatory diseases of the colon; underwent polypectomy surgery, colon surgery, as wel as patients older 50.

Preparation for colonoscopy

The quality and diagnostic value of colonoscopy is highly dependent on the quality of preparation.

A day before start the preparation, it is required a slag-free diet (exclude plant-based food like fruits, vegetables, berries, grapes, cereals, brown bread, colored and carbonated drinks, activated carbon and bismuth medications ("de-nol", "vicalin"). If the patient is constipated and takes laxatives, a slag-free diet should be in place for 2 days and transited to liquid food a day before preparing for the procedure.

To cleanse the intestines, we recommend the "Fortrans" in a two steps: 2 liters in the evening and 2 liters in the morning on the day of the procedure - this way the medication is better tolerated by patients and ensures high-quality intestines cleaning. We also consider that cleansing with Fortrans" is simpler and more reliable.

Features of preparation with the "Fortrans": 

• It is necessary to refuse to take solid food on the day of preparation for colonoscopy. The last intake of liquid food should be at 15:00 on the day of preparation.
• Dissolve 1 sachet of the medication in 1 liter of drinking water. It is allowed to add lemon, orange, or grapefruit juice to improve the taste.
• Drink 1 liter of "Fortrans" solution within an hour: 250 ml every quarter of an hour or in small portions non-stop.
• For complete cleaning, you need to drink 4 liters of solution (that are 4 sachets of "Fortrans");
• Add 30 drops of "Espumizan" ("Simethicone") to the last portion of "Fortran";
• It is necessary to finish taking the "Fortrans" solution at least 3 hours before the colonoscopy;

Our recommendations for scheduling "Fortrans" intake:

If the procedure is scheduled for tomorrow at 9:00 a.m.:

Start taking the "Fortrans" solution at 18:00:

- from 18:00 to 19:00 take the first liter of solution

- from 19:00 to 20:00 take the second liter of solution

- from 20:00 to 21:00 take the third liter of solution

- from 21:00 to 22:00 take a fourth liter of "Fortrans" solution with 30 "Espumizan" drops.

If the procedure is scheduled for tomorrow at 11:00 a.m. or 12:00 p.m.:

Start taking the solution at 18:00:

- from 18:00 to 19:00 take the first liter of solution

- from 19:00 to 20:00 take the second liter of solution

- in the morning, on the day of the colonoscopy, from 6:00 a.m. to 7:00 a.m., take the third liter of solution

- from 7:00 to 8:00 take a fourth liter of "Fortrans" solution with 30 "Espumizan" drops.

The effect of the medication begins already after the first liter and ends 2-3 hours after taking the last portion. The presence of watery, transparent or slightly cloudy contents in the last stools is evidence of good results of intestines cleaning and proper prefaration to the examination. 

Contraindications to colonoscopy:

The following diseases are contraindications to colonoscopy.

Absolute:
• agonal state
• perforation of a hollow organ
• severe systemic disease (ASA III);
• acute myocardial infarction;
• large aortic aneurysm.

Relative:
• suspicion of perforation;
• peritonitis;
• acute infectious diseases;
• severe forms of non-specific ulcerative colitis and Crohn's disease, diverticulitis;
• hemical burns of the colon in the acute stage;
• inflammation of the perianal area, narrowing of the anus, thrombosis of hemorrhoidal nodes;
• large ventral hernias;
• multiple diverticula of large sizes;
• early postoperative period.

The quality of endoscopic examinations in «Manufactura» clinic

We guarantee the comfort and safety of diagnostic endoscopic examinations thanks to well professional and experienced doctors, high-quality endoscopic equipment, as well as treatment and diagnostics standards following EAES (European Association for Endoscopic Surgery and other Interventional Techniques) and UEG (United European Gastroenterology) protocols.

Our proctologiests and gastroenterologists are well professional and experienced in diagnosis and treatment. We guarantee the comfort and safety of diagnostic endoscopic examinations due to high-quality endoscopic equipment and responsibility of our doctors. All the invasive manupulations and treatments are performed in accordance with EAES (European Association for Endoscopic Surgery and other Interventional Techniques) protocols and UEG (United European Gastroenterology).