Intervention: Colonoscopy
ICD-10 code:
ICD-9 code:	45.23
MeSH	D003113
Other codes:

Colonoscopy is the endoscopic examination of the large colon and the distal part of the small bowel with a CCD camera or a fiber optic camera on a flexible tube passed through the anus. It may provide a visual diagnosis (e.g. ulceration, polyps) and grants the opportunity for biopsy or removal of suspected lesions. Virtual colonoscopy, which uses 2D and 3D imagery reconstructed from computed tomography (CT) scans or from nuclear magnetic resonance (MR) scans, is also possible, as a totally non-invasive medical test, although it is not standard and still under investigation regarding its diagnostic abilities. Furthermore, virtual colonoscopy does not allow for therapeutic maneuvers such as polyp/tumor removal or biopsy nor visualization of lesions smaller than 5 millimeters. If a growth or polyp is detected using CT colonography, a standard colonoscopy would still need to be performed. Colonoscopy can remove polyps smaller than one millimeter. Once polyps are removed, they can be studied with the aid of a microscope to determine if they are precancerous or not. Colonoscopy is similar but not the same as sigmoidoscopy. The difference between colonoscopy and sigmoidoscopy is related to which parts of the colon each can examine. Sigmoidoscopy allows doctors to view only the final two feet of the colon, while colonoscopy allows an examination of the entire colon, which measures four to five feet in length. Often a sigmoidoscopy is used as a screening procedure for a full colonoscopy. In many instances a sigmoidoscopy is performed in conjunction with a fecal occult blood test (FOBT), which can detect the formation of cancerous cells throughout the colon. Image File history File links Size of this preview: 554 × 599 pixelsFull resolution (750 × 811 pixel, file size: 75 KB, MIME type: image/jpeg) Image used on French Wikipedia page http://fr. ... The International Classification of Health Interventions (ICHI) is a system of classifying procedure codes being developed by the World Health Organization. ... ICD-9-CM Volume 3 is a system of Procedural codes. ... Medical Subject Headings (MeSH) is a huge controlled vocabulary (or metadata system) for the purpose of indexing journal articles and books in the life sciences. ... Procedure codes are numbers or alphanumeric codes used to identify specific health interventions taken by medical professionals. ... Endoscopic images of a duodenal ulcer A flexible endoscope. ... It has been suggested that this article or section be merged with Large intestine. ... Not to be confused with ilium (bone). ... A charge-coupled device (CCD), is an integrated circuit containing an array of linked, or coupled, capacitors. ... Fiber Optic strands An optical fiber in American English or fibre in British English is a transparent thin fiber for transmitting light. ... This article is about the bodily orifice. ... An ulcer (from Latin ulcus) is an open sore of the skin, eyes or mucous membrane, often caused by an initial abrasion and generally maintained by an inflammation and/or an infection. ... Brain biopsy A biopsy (in Greek: bios = life and opsy = look/appearance) is a medical test involving the removal of cells or tissues for examination. ... Virtual colonoscopy (VC) is a Medical imaging procedure which uses x-rays and computers to produce two- and three-dimensional images of the colon (large intestine) from the lowest part, the rectum, all the way to the lower end of the small intestine and display them on a screen. ... negron305 Cat scan redirects here. ... NMR redirects here. ... The term non-invasive in medicine has two meanings: A medical procedure which does not penetrate or break the skin or a body cavity, i. ... Sigmoidoscope inserted through the anus and rectum and into the sigmoid colon. ...

Uses

Indications for colonoscopy include gastrointestinal hemorrhage, unexplained changes in bowel habit or suspicion of malignancy. Colonoscopies are often used to diagnose colon cancer, but are also frequently used to diagnose inflammatory bowel disease. In older patients (sometimes even younger ones) an unexplained drop in hematocrit (one sign of anemia) is an indication to do a colonoscopy, usually along with an EGD (esophagogastroduodenoscopy), even if no obvious blood has been seen in the stool (feces). Gastrointestinal hemorrhage can be roughly divided into two clinical syndromes: upper gastrointestinal bleed, characterized by hematemesis and lower gastrointestinal bleed, characterized by melena or hematochezia. ... When normal cells are damaged or old they undergo apoptosis; cancer cells, however, avoid apoptosis. ... Diagram of the stomach, colon, and rectum Colorectal cancer includes cancerous growths in the colon, rectum and appendix. ... In medicine, inflammatory bowel disease (IBD) is a group of inflammatory conditions of the large intestine and, in some cases, the small intestine. ... The hematocrit (Ht or HCT) and packed cell volume (PCV) are measures of the proportion of blood volume that is occupied by red blood cells. ... This article discusses the medical condition. ... In medicine (gastroenterology), esophagogastroduodenoscopy (EGD) or upper endoscopy is a diagnostic endoscopic procedure that visualises the upper part of the gastrointestinal tract. ... Horse feces Feces, faeces, or fæces (see spelling differences) is a waste product from an animals digestive tract expelled through the anus (or cloaca) during defecation. ...

Fecal occult blood is a quick test which can be done to test for microscopic traces of blood in the stool. A positive test is almost always an indication to do a colonoscopy. In most cases the positive result is just due to hemorrhoids; however, it can also be due to diverticulosis, inflammatory bowel disease (Crohn's disease, ulcerative colitis), colon cancer, or polyps. However--since its development by Dr. Hiromi Shinya in the 1960s--polypectomy has become a routine part of colonoscopy, allowing for quick and simple removal of polyps without invasive surgery.^[1] Fecal occult blood is a term for blood present in the feces that is not visibly apparent. ... Hemorrhoids (also haemorrhoids or piles) are varicosities or swelling and inflammation of veins in the rectum and anus. ... Diverticulosis, otherwise known as diverticular disease, is the condition of having diverticula in the large colon which are outpocketings of the colonic mucosa and submucosa through weaknesses of muscle layers in the colon wall. ... Crohns disease (also known as regional enteritis) is a chronic, episodic, inflammatory bowel disease (IBD) and is generally classified as an autoimmune disease. ... Polyp of sigmoid colon as revealed by colonoscopy. ... Polypectomy is the removal of a polyp through coloscopy or endoscopy. ...

Due to the high mortality associated with colon cancer and the high effectivity and low risks associated with colonoscopy, it is now also becoming a routine screening test for people 50 years of age or older. Subsequent rescreenings are then scheduled based on the initial results found, with a five- or ten-year recall being common for colonoscopies that produce normal results.^{[citation needed]}

Procedure

Preparation

The colon must be free of solid matter for the test to be performed properly. For one to three days, the patient is required to follow a low fibre or clear-fluid only diet. Examples of clear fluids are apple juice, bouillon, artificially flavored lemon-lime soda or sports drink, and of course water. It is very important that the patient remains hydrated. As orange juice, prune juice, and milk contain fibre, they are banned from the list, as are liquids dyed red, orange, purple, or brown, such as cola. However, in most cases black coffee is allowed. The day before the colonoscopy, the patient is either given a laxative preparation (such as Bisacodyl, phospho soda, sodium picosulfate, or sodium phosphate and/or magnesium citrate) and large quantities of fluid or whole bowel irrigation is performed using a solution of polyethylene glycol and electrolytes. --Bouillon-- Is, in French Cuisine, simply a broth. ... Laxatives (or purgatives) are foods, compounds, or drugs taken to induce bowel movements or to loosen the stool, most often taken to treat constipation. ... Bisacodyl is the International Nonproprietary Name of a compound that functions as a stimulant laxative. ... Phospho-soda is a powder that is available over the counter either by itself or as part of a kit that also includes a laxative and an enema or suppository. ... Sodium picosulfate (INN, also known as sodium picosulphate) is a contact laxative used as a treatment for constipation or to prepare the large bowel before colonoscopy or surgery. ... Sodium phosphate (Na3PO4) is a phosphate of sodium. ... Magnesium citrate is a chemical agent used medicinally as a laxative and to empty the bowel prior to a surgery or colonoscopy. ... Whole bowel irrigation (WBI) is a medical process involving the rapid administration of large volumes of an osmotically balanced polyethylene glycol solution (GoLYTELY®, CoLyte®), either orally or via a nasogastric tube, to flush out the entire gastrointestinal tract. ... Polyethylene glycol (PEG) and polyethylene oxide (PEO) are polymers composed of repeating subunits of identical structure, called monomers, and are the most commercially important polyethers. ... An electrolyte is a substance which dissociates free ions when dissolved (or molten), to produce an electrically conductive medium. ...

Since the goal of the preparation is to clear the colon of solid matter, the patient should plan to spend the day at home in comfortable surroundings with ready access to toilet facilities. The patient may also want to have at hand moist toilettes or a bidet for cleaning the anus. A soothing salve such as petroleum jelly applied after cleaning the anus will improve patient comfort. For other uses, see Toilet (disambiguation). ... A toilet (left) and a bidet (right). ... This article is about the bodily orifice. ... White Petrolatum Petroleum jelly, vaseline, petrolatum or soft paraffin [2] is a semi-solid mixture of hydrocarbons (with carbon numbers mainly higher than 25),[3] originally promoted as a topical ointment for its healing properties. ...

The patient may be asked to skip aspirin and aspirin-like products such as salicylate, ibuprofen, and similar medications for up to ten days before the procedure to avoid the risk of bleeding if a polypectomy is performed during the procedure. A blood test may be performed before the procedure.^[2][3] Salicylic acid is a colorless, crystalline organic carboxylic acid. ... Coated 200 mg ibuprofen tablets Ibuprofen (INN) (IPA: ) (from the earlier and no longer correct nomenclature iso-butyl-propanoic-phenolic acid) is a non-steroidal anti-inflammatory drug (NSAID) originally marketed as Brufen, and since then under various other trademarks (see tradenames section), most notably Advil. ...

The investigation

During the procedure the patient is often given sedation intravenously, employing agents such as midazolam or fentanyl. Although meperidine (Demerol) may be used as an alternative to fentanyl, the concern of seizures has relegated this agent to second choice for sedation behind the combination of midazolam and fentanyl. The average person will receive a combination of these two drugs, usually between 1-4 mg IV midazolam, and 25 to 100 µg IV fentanyl. Sedation practices vary between practitioners and nations; in some clinics in Norway, sedation is rarely administered.^[4][5] Some endocoscopists are experimenting with, or routinely use, alternative or additional methods such as nitrous oxide^[6][7] and propofol^[8], which have advantages and disadvantages relating to recovery time (particularly the duration of amnesia after the procedure is complete), patient experience, and the degree of supervision needed for safe administration. This sedation is called "twilight anesthesia" and for some patients it doesn't take and they are indeed awake for the procedure and watch the inside of their colon on the color monitor. Sedation is a medical procedure involving administration of sedative drugs, generally to facilitate a medical procedure, such as endoscopy, vasectomy, or minor surgery with local anaesthesia. ... Midazolam (marketed under brand names Versed®, Hypnovel®, Dormicum® and Dormonid®, pronounced ) is a drug which is a benzodiazepine derivative. ... Fentanyl is an opioid analgesic, first synthesized by Janssen Pharmaceutica (Belgium) in the late 1950s, with a potency many times that of morphine. ... Midazolam (marketed under brand names Versed®, Hypnovel®, Dormicum® and Dormonid®, pronounced ) is a drug which is a benzodiazepine derivative. ... Fentanyl is an opioid analgesic, first synthesized by Janssen Pharmaceutica (Belgium) in the late 1950s, with a potency many times that of morphine. ... For other uses, see Nitrous oxide (disambiguation). ... Propofol is a short-acting intravenous anesthetic agent used for the induction of general anesthesia in adult patients and pediatric patients older than 3 years of age; maintenance of general anesthesia in adult patients and pediatric patients older than 2 months of age; and sedation in medical contexts, such as...

The first step is usually a digital rectal examination, to examine the tone of the sphincter and to determine if preparation has been adequate. The endoscope is then passed though the anus up the rectum, the colon (sigmoid, descending, transverse and ascending colon, the cecum), and ultimately the terminal ileum. The endoscope has a movable tip and multiple channels for instrumentation, air, suction and light. The bowel is occasionally insufflated with air to maximize visibility. Biopsies are frequently taken for histology. A rectal examination or rectal exam is an internal examination of the rectum by a physician. ... Look up Sphincter in Wiktionary, the free dictionary. ... Endoscopic images of a duodenal ulcer A flexible endoscope. ... This article is about the bodily orifice. ... The rectum (from the Latin rectum intestinum, meaning straight intestine) is the final straight portion of the large intestine in some mammals, and the gut in others, terminating in the anus. ... It has been suggested that this article or section be merged with Large intestine. ... Not to be confused with ilium (bone). ... A thin section of lung tissue stained with hematoxylin and eosin. ...

In most experienced hands, the endoscope is advanced to the junction of where the colon and small bowel join up (cecum) in under 10 minutes in 95% of cases. Due to tight turns and redundancy in areas of the colon that are not "fixed", loops may form in which advancement of the endoscope creates a "bowing" effect that causes the tip to actually retract. These loops often result in discomfort due to stretching of the colon and its associated mesentery. Maneuvers to "reduce" or remove the loop include pulling the endoscope backwards while torquing the instrument. Alternatively, body position changes and abdominal support from external hand pressure can often "straighten" the endoscope to allow the scope to move forward. In a minority of patients, looping is often cited as a cause for an incomplete examination. Usage of alternative instruments leading to completion of the examination has been investigated, including use of pediatric colonscope, push enteroscope and upper GI endoscope variants.^[9] The cecum or caecum (from the Latin caecus meaning blind) is a pouch connected to the ascending colon of the large intestine and the ileum. ... In anatomy, a mesentery is a part of the peritoneum that connects an internal organ, such as the small intestine, to the abdominal wall. ...

For screening purposes, a closer visual inspection is then often performed upon withdrawal of the endoscope over the course of 20 to 25 minutes. Lawsuits over missed cancerous lesions have prompted recent institutions to better document withdrawal time as rapid withdrawal times may be a source of potential medical legal liability.^[10] This is often a real concern in private practice settings where high throughput of cases have been postulated as a financial incentive to complete colonoscopies as quickly as possible.

Suspicious lesions may be cauterized, treated with laser light or cut with an electric wire for purposes of biopsy or complete removal polypectomy. Medication can be injected, e.g. to control bleeding lesions. On average, the procedure takes 20-30 minutes, depending on the indication and findings. With multiple polypectomies or biopsies, procedure times may be longer. As mentioned above, anatomic considerations may also affect procedure times. Cauterization is a medical term describing the burning of the body to remove or close a part of it. ... For other uses, see Laser (disambiguation). ... Brain biopsy A biopsy (in Greek: bios = life and opsy = look/appearance) is a medical test involving the removal of cells or tissues for examination. ... Polypectomy is the removal of a polyp through coloscopy or endoscopy. ...

After the procedure, some recovery time is usually allowed to let the sedative wear off. Outpatient recovery time can take an estimate of 30-60 minutes. Most facilities require that patients have a person with them to help them home afterwards (again, depending on the sedation method used).

One very common aftereffect from the procedure is a bout of flatulence and minor wind pain caused by air insufflation into the colon during the procedure. Flatulence is the presence of a mixture of gases in the digestive tract of mammals. ...

An advantage of colonoscopy over x-ray imaging or other, less invasive tests, is the ability to perform therapeutic interventions during the test. A polyp is a growth of excess of tissue that can develop into cancer. If a polyp is found, for example, it can be removed by one of several techniques. A snare can be placed around a polyp for removal. Even if the polyp is flat on the surface it can often be removed. For example, the following show a polyp removed in stages:

Polyp is identified	A sterile solution is injected under the polyp to lift it away from deeper tissues.	A portion of the polyp is now removed.	The polyp is fully removed.

Image File history File links No higher resolution available. ... Image File history File links Metadata No higher resolution available. ... Image File history File links Metadata No higher resolution available. ... Image File history File links Metadata No higher resolution available. ...

Risks

This procedure has a low (0.2%) risk of serious complications.^{[citation needed]}

The most serious complication is a tear or hole in the lining of the colon called a gastrointestinal perforation, which is life-threatening and requires immediate major surgery for repair; however, the rate of perforation is less than 1 in 2000 colonoscopies. Gastrointestinal perforation is a complete penetration of the wall of the stomach, small intestine or large bowel, resulting in intestinal contents flowing into the abdominal cavity. ...

Bleeding complications may be treated immediately during the procedure by cauterization via the instrument. Delayed bleeding may also occur at the site of polyp removal up to a week after the procedure and a repeat procedure can then be performed to treat the bleeding site. Even more rarely, splenic rupture can occur after colonoscopy because of adhesions between the colon and the spleen. Cauterization is a medical term describing the burning of the body to remove or close a part of it. ... Rupture of the capsule of the spleen, an organ in the upper left part of the abdomen, is a potential catastrophe that requires immediate medical and surgical attention. ...

As with any procedure involving anaesthesia, other complications would include cardiopulmonary complications such as temporary drop in blood pressure and oxygen saturation, usually the result of overmedication and easily reversed. In rare cases, more serious cardiopulmonary events such as a heart attack, stroke, or even death may occur; these are extremely rare except in critically ill patients with multiple risk factors. Anesthesia (AE), also anaesthesia (BE), is the process of blocking the perception of pain and other sensations. ... Wikibooks has more about this subject: First Aid/CPR Cardiopulmonary resuscitation (CPR) is an emergency first aid protocol for a victim of cardiac arrest. ... Complication, in medicine, is a unfavorable evolution of a disease, a health condition or a medical treatment. ... A sphygmomanometer, a device used for measuring arterial pressure. ... Oxygen saturation is a relative measure of the amount of oxygen that is dissolved or carried in a given medium. ... Overmedication is when a doctor prescribes unnecessary or excessive medication to a patient. ... Heart attack redirects here. ... For other uses, see Stroke (disambiguation). ...

On very rare occasions, intracolonic explosion may occur.

References

Year 2007 (MMVII) was a common year starting on Monday of the Gregorian calendar in the 21st century. ... is the 163rd day of the year (164th in leap years) in the Gregorian calendar. ... Year 2007 (MMVII) was a common year starting on Monday of the Gregorian calendar in the 21st century. ... is the 163rd day of the year (164th in leap years) in the Gregorian calendar. ... ISSN, or International Standard Serial Number, is the unique eight-digit number applied to a periodical publication including electronic serials. ... Year 2007 (MMVII) was a common year starting on Monday of the Gregorian calendar in the 21st century. ... is the 163rd day of the year (164th in leap years) in the Gregorian calendar. ... Year 2007 (MMVII) was a common year starting on Monday of the Gregorian calendar in the 21st century. ... is the 163rd day of the year (164th in leap years) in the Gregorian calendar. ... Year 2007 (MMVII) was a common year starting on Monday of the Gregorian calendar in the 21st century. ... is the 163rd day of the year (164th in leap years) in the Gregorian calendar. ... Year 2007 (MMVII) was a common year starting on Monday of the Gregorian calendar in the 21st century. ... is the 163rd day of the year (164th in leap years) in the Gregorian calendar. ... Year 2007 (MMVII) was a common year starting on Monday of the Gregorian calendar in the 21st century. ... is the 163rd day of the year (164th in leap years) in the Gregorian calendar. ... Blackwell Publishing was formed in 2001 from two Oxford-based academic publishing companies, Blackwell Science and Blackwell Publishers and is the worlds leading society publisher, partnering with 665 academic and professional societies. ...

See also

• Anal probe
• Bow and arrow sign
• Polypectomy
• Rectal examination
• Virtual colonoscopy

... Colonscopy image of the cecum showing a bow and arrow sign. ... Polypectomy is the removal of a polyp through coloscopy or endoscopy. ... A rectal examination or rectal exam is an internal examination of the rectum by a physician or other healthcare professional. ... Virtual colonoscopy (VC) is a Medical imaging procedure which uses x-rays and computers to produce two- and three-dimensional images of the colon (large intestine) from the lowest part, the rectum, all the way to the lower end of the small intestine and display them on a screen. ...

External links

• Colonoscopy. Based on public-domain NIH Publication No. 02-4331, dated February 2002.
• Patient Education Brochures. American Society for Gastrointestinal Endoscopy information
• "How I Do It" — Removing large or sessile colonic polyps. Dr. Brian Saunders MD FRCP; St. Mark’s Academic Institute; Harrow, Middlesex, UK. Retrieved April 9, 2008.