colonoscopy

colonoscopy, a medical examination of the interior of the colon (large intestine), rectum, and anus, by the insertion of a narrow, flexible, lighted tube called a colonoscope. A tiny video camera on the end of the tube transmits images of the colon to an external monitor. A colonoscopy, which is a type of endoscopy, can be used as a screening, diagnostic, or therapeutic tool.

Uses

One of the most important uses of colonoscopy is as a screening tool for colon cancer and rectal cancer (also called colorectal cancer). This type of cancer, which usually develops from abnormal growths called polyps, often has no symptoms. Most polyps are benign, but some are precancerous. Colonoscopies are also used to assess patients with symptoms such as abdominal pain, cramps, chronic diarrhea, constipation, incontinence, blood in the stool, and unexplained weight loss. A colonoscopy can help physicians diagnose inflammatory bowel disease, including Crohn disease and ulcerative colitis; ulcers; perforations; diverticulitis; and intestinal ischemia and ischemic colitis.

Testing demographics

Physicians recommend that people who are 45–75 years old and at average risk of colorectal cancer get a colonoscopy every 10 years. Risk factors include smoking, obesity, having a family history of colorectal polyps or colorectal cancer, having a personal history of inflammatory bowel disease, and having hereditary nonpolyposis colorectal cancer (HNPCC, also known as Lynch syndrome) or familial adenomatous polyposis (FAP). After age 75, physicians may or may not recommend further screening for colorectal cancer, depending on a patient’s health and screening history.

Preparation and procedure

During a colonoscopy, a gastroenterologist looks for polyps, tissue that is irritated or swollen, signs of cancer, ulcers, and other abnormalities and will remove all polyps that they find and may also take other tissue samples called biopsies. The gastroenterologist may also perform other treatments during a colonoscopy, including placing stents, injecting medications, closing wounds, and removing blockages.

The patient is given sedatives—either general anesthesia or medications that induce conscious sedation—and pain medication, and the gastroenterologist inserts the colonoscope through the anus into the rectum. Air, carbon dioxide, or water are pumped into the colon through a channel in the colonoscope in order to inflate the colon and make it easier to examine. Other medical instruments can be inserted through the channel in the colonoscope to remove polyps or to take biopsies. Complications associated with colonoscopy, which are rare, include abnormal reactions to sedatives, bleeding caused by polyp removal or biopsy, perforation of the colon or rectum wall, and infection. If the results of a colonoscopy are negative, no abnormal tissue was found, and another colonoscopy may be recommended in 10 years if the patient is at average risk for colorectal cancer and has no risk factors other than age. A positive result indicates that polyps or abnormal tissues were detected, which may lead to treatment for a condition; additional colonoscopies may also be recommended within 10 years.

Physicians usually ask patients to eat low-fibre foods for a few days before a colonoscopy and to stick to a clear liquid diet the day before the procedure. Additionally, patients must clean out their colons with a laxative, because stool may block the video camera. Patients should consult with their physician about medications that they take regularly to determine whether they should temporarily stop taking them or adjust the dosages before the procedure.