Colonoscopy

By | 9 March 2021

What is a colonoscopy?

Colonoscopy is the examination of the large intestine, which is a hollow organ, with a flexible instrument called a colonoscope.

Extra-intestinal compression: provides information about the abnormalities of the intestinal wall and pathologies in the intestinal cavity.

Intestinal wall abnormalities: Include tumor, polyps, diverticula, colitis, vascular pathologies.

Intestinal cavity pathologies: Petrified feces, foreign bodies, parasites, torsion, and the like.

Colonoscopy gives the doctor a chance to see inflamed tissues, abnormal growths (masses), and ulcers. Colonoscopy is the most common examination for the early diagnosis of colon and rectal cancers. At the same time, colonoscopy is used to investigate unexplained changes in bowel movements (such as prolonged diarrhea, constipation), abdominal pain, rectal bleeding, weight loss.

Who Can Have Colonoscopy?

The ideal is to have a colonoscopic examination in the absence of symptoms. Thus, it is possible to diagnose at an early stage and to apply more permanent treatment before diseases occur or if they have occurred.

Especially those with relatives with colon cancer are recommended to have a colonoscopy when symptoms are absent. Economic and physical conditions do not allow everyone to perform a colonoscopy in the absence of symptoms. However, a colonoscopy should be done in the following situations.

• Those who have rectal bleeding or have occult blood in their stool

• People with colon cancer in first-degree relatives

• Those with a history of bowel cancer or polyps.

• Those with a suspicious appearance in intestinal films.

• People with uterine cancer, ovarian cancer, and breast cancer in their families.

• To investigate the cause of diarrhea in those with persistent diarrhea

• Those with inflammatory bowel disease (ulcerative colitis, Crohn’s disease).

• In unexplained weight loss.

• Finding the main focus in patients with common cancer

• Those who have abdominal pain that does not resolve with treatment and whose cause cannot be found.

How Is Colonoscopy Performed?

Colonoscopy is usually done without hospitalization. Patients are considered to have had bowel cleansing, except in an emergency. His complaints, all examinations, previous illnesses, medications he used, and surgeries he has undergone are carefully questioned. The colonoscopy procedure is explained to the patient in detail by the physician. Vascular access is established to give patients the necessary medications intravenously. The vital signs of the patient (heart rate, blood oxygen level) are monitored.

After these preparations are made, the patient is positioned and drugs that provide sedation are made. This intravenous drug (Midazolam and/or Pethidine HCl) is used for less pain and/or painless administration during the colonoscopy procedure. Medication (buscopan) can also be used for bowel relaxation. The patient falls asleep with the effect of the medications given. Unless it is very necessary, full anesthesia is not applied.

Before applying the colonoscope to the patient, the breach region is seen under the light by pulling the buttocks to the sides. With gel (lubricant) taken on the right index finger, the finger is inserted into the anus and the rectal finger is examined (rectal touch). Then the colonoscopy device is carefully pushed into the anus and the colonoscopy procedure is started. The cecum is reached bypassing the rectum, rectosigmoid region, sigmoid colon, descending colon, transverse colon, and ascending colon respectively. Then, the last part of the small intestine is entered through the cecum. This place is called the terminal ileum. Examination of this last 20 cm part of the small intestine is very important in the diagnosis of inflammatory bowel diseases such as Crohn’s disease, which tend to involve in particular. In a colonoscopy, the actual examination is done while the colonoscope is withdrawn. This pull should take at least 10 minutes.

During a colonoscopy, therapeutic procedures can be performed, provided that the prior consent of the patient and/or relatives is obtained. For example, polyps that have the potential to turn into bowel cancer can be easily removed by the polypectomy method.

After the colonoscopy is completed, the patient is awakened. Another drug (flumazenil) can be used to accelerate this awakening process and to end the effect of sedating drugs.

Why is a colonoscopy done?

Colonoscopy is used in the diagnosis, treatment, and follow-up of diseases seen in both the large intestine and the last part of the small intestine. In addition, colonoscopy is performed for the treatment of some of these diseases.

These diseases;

  • Inflammatory bowel diseases (ulcerative colitis, Crohn’s disease, infectious colitis, etc.)
  • Benign intestinal tumors (polyps, lipoma)
  • Bowel cancers
  • Diverticula
  • Vascular pathologies
  • Torsions
  • Ulcers
  • Bleeding

Therapeutic Interventions;

  • Polypectomy (removal of polyps)
  • Cauterization (burning of bleeding lesions using electrical energy to stop bleeding)
  • Sclerotherapy (injection of anti-bleeding drugs)
  • Dilatation (Widening of narrowed bowel regions)
  • Detorsion (correction of the large intestine turning around itself)
  • Foreign body removal
  • Tracking
  • Cancer patients
  • Polyp patients
  • Inflammatory bowel diseases
  • Bleeding

It is used in the follow-up of patients with a high probability of colon cancer.

What is the Importance of Colonoscopy?

The mortality rate due to colon and rectal cancer is estimated to be 500,000 worldwide. Colon and rectal cancer incidence increase with age. (especially over the age of 60). In the United States, the lifetime probability of developing colon and rectal cancer has been reported as 6%.

As it is clearly seen in the paragraphs above, when expressed in numerical values, the frequency and lethality of colon cancer scare people. A colonoscopy is an indispensable tool in the diagnosis and treatment of such important diseases.

When Is the Colonoscopy Result Obtained?

Your doctor who performs the colonoscopy will immediately evaluate the result and inform you about the diseases and treatments if any. If the piece (biopsy) is taken, it will be necessary to wait a few days for the result.

Immediately after the examination, it is recommended that you come to the unit where you will have a colonoscopy with a relative to have a conversation with your doctor. Because patients often forget what was told to them with the effect of the injection.

If the piece is taken, when you get the result, you should definitely talk to your doctor who wants the test.