Preparing for Colonoscopy: You have to go through a colonoscopy, and this scares you. No panic, it is not painful. It requires only a small preparation, explained Bruno Richard-Mallard, gastroenterologist and president of the French Society of Digestive Endoscopy, on the occasion of “Mars bleu,” colorectal cancer awareness and detection month.
Colonoscopy, what’s the point?
Colonoscopy is used to observe the rectum, colon (large intestine) and a small part of the small intestine. It allows the detection of diseases of the rectum or colon. In the case of screening, 20 to 25% of the cases reveal the presence of polyps in humans, 15-20% of women, which can cause cancer. However, colonoscopy is not equal to cancer!
Colonoscopy is prescribed when the patient complains of abdominal pain, transit disorder, bleeding of the anus … There are also other situations where your doctor may ask for a colonoscopy:
– If there is a high risk of developing cancer, for genetic reasons such as Lynch’s syndrome (polyposis hereditary colorectal cancer), or family polyposis. The examination is then recommended as early as 25 years, every two years.
– As part of the proper screening for colorectal cancer, from 50 years. The doctor first does a blood test in your stool (test Hemoculture). If positive, it prescribes a colonoscopy. A new test is promised by the authorities for the end of 2014. This is the Fec (Fecal immunologic test), an immunoassay that is more efficient than the current Hemocculte test, insofar as sensitivity and specificity Are significantly better, detecting more cancers and polyps.
– It is systematically prescribed from the age of 45 in the case of personal or family history (polyps, colon cancer). An exam to pass then every five years.
Patients can also request it, from age 50, to be reassured and to protect themselves from possible cancer because the colonoscopy protects! Indeed, the doctor who carries out this examination removes the polyps he discovers. However, they are often the cause of colorectal cancer. This reduces the patient’s risk.
How does it work?
The device is a long and flexible tube, called a colonoscope, a little bigger than that used for gastroscopy. It measures 1.30 meters, is about 1 cm in diameter and has at its end a CCD sensor (a camera) which allows reproducing the image on the doctor’s screen.
In the endoscope, there is what is called an operator channel that allows air or CO2 to be injected to make the colon more visible and easier to see. The doctor can also introduce tools to cut polyps and dissect tumors.
Only a gastroenterologist is authorized to perform this examination. This specialist is used to carry out colonoscopies since more than one million are practiced every year in USA.
The appointment can be obtained relatively quickly.
What preparation for the patient?
Beforehand, you will have an appointment with the anesthetist and the gastroenterologist who will explain all the stages of development.
– Three days before colonoscopy, you will have to follow a diet without residue (i.e., without bread, without dairy, without fruit, without fiber). You will mainly be entitled to starchy foods (rice, pasta).
– Then you will do what is called a two-stage preparation. The evening before, you will have to drink a laxative. Moreover, on the morning of the exam, you will take it back in smaller quantity. This represents a total of 3 to 4 liters of liquid to drink. Purpose: Wash the intestine. This is often the most difficult part for the patient.
How does it work on D-Day?
The same day you arrive on an empty stomach. Lying on his back, naked and covered with a small blanket, the anesthesiologist comes to sleep. For reasons of comfort and safety, this examination always takes place under general anesthesia and lasts about twenty minutes. The gastroenterologist begins colonoscopy by introducing the endoscope gently into the anus. As you are asleep, you will feel no pain. If the doctor sees polyps, he removes them. Colonoscopy is a direct diagnostic and interventional examination. However, if the lesions identified are too large, the patient is entrusted to the surgeon.
Nice to know: even if this examination is carried out on an outpatient basis, you will not be able to go home alone at the wheel of your car because you have undergone general anesthesia. So plan to be accompanied.
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Colonoscopy: contraindications and risks
The contraindications associated with colonoscopy are those of general anesthesia. If the patient has serious respiratory or cardiac problems, he/she will not be able to perform this examination. It can then pass a virtual colonoscopy by scanning (but one sees much less well, notably some plane polyps). Another possibility, little widespread still: the patient swallows a capsule that allows reproducing images of the colon. However, these exams are not as accurate as colonoscopy and do not remove polyps. Moreover, the videocolic capsule is not refunded.
The potential risks of a colonoscopy are those inherent in general anesthesia but are exceedingly rare. Bleeding may also occur when removing polyps or perforating the intestine. However, again, these cases are rare and well managed by medical teams.
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