Colonoscopy

You will receive instructions from your doctor at GI Alliance regarding the necessary bowel preparation to get you ready for your exam. Most patients will be on clear liquids the entire day before the exam. There are several different options for laxatives to entirely clean out the colon. It is very important to follow the instructions given to you by your doctor. There will also be additional instructions regarding your medications. In most cases, your medications will be continued as usual. However, in certain circumstances, especially in patients on blood thinners (i.e., Coumadin, warfarin, Plavix, aspirin, anti-inflammatories) and in diabetics, special instructions will be given. Patients will be instructed not to take anything by mouth after midnight except for medications.

You will be asked to arrive at the endoscopy center at your local GI Alliance location 1 – 1.5 hours before your exam. This is to allow time to fill out paperwork and prepare for the exam. You will be asked to change into a medical gown. An intravenous (IV) catheter will be started in your arm so that sedation can be administered. You will be connected to equipment that will allow the doctor and staff to monitor your heart rate, blood pressure, pulse, electrocardiogram, breathing, and oxygen level during and after the exam.

Once in the exam room, you will be asked to lie on your left side on the stretcher. The IV sedation will be started. Small amounts are given to ensure your safety and provide only the amount you need individually. Once an adequate level of sedation is achieved, the physician will perform a rectal exam. The colonoscope will then be gently inserted into the rectum. The scope will be carefully advanced throughout the colon to where the small bowel and colon meet. A small amount of air is placed through the scope and into the colon to help the physician see. Any fluid remaining in the colon after the preparation can be washed and suctioned out through the scope.

Depending on the findings of the exam, several things can be done at the time of the procedure, including biopsies, the removal of polyps, and the control of bleeding. At the end of the procedure, as much of the air and remaining fluid as possible is suctioned out of the colon through the scope. Depending on the findings, the exam takes approximately 15 – 30 minutes.

After the exam is complete, you will be taken to the recovery room to be monitored while the sedation starts to wear off. The amount of sedation used during the exam and your individual response to the medication will dictate how quickly you will wake up, though most patients are awake enough for discharge within 45 – 60 minutes.

You will not be allowed to drive for the rest of the day; therefore, you will need to arrange for a ride home. You will also be instructed not to work, sign important papers, or perform strenuous activities for the rest of the day. Most patients are able to eat and drink normally after their discharge from the Endoscopy unit; however, specific instructions regarding activity, eating, and medications will be given prior to discharge.

After the exam, the doctor and/or nurse will go over the findings of the procedure with you. Most patients will not remember what they are told after the exam because of the effects of the sedation. It is recommended, if possible, to bring someone with you to whom the results can also be discussed. You will also go home with a typed report. You will be informed of any biopsy results usually within one week.

To an extent, the alternatives to the exam will depend on the reason for needing to undergo the colonoscopy in the first place. In most cases, a colonoscopy is the best method to evaluate and treat abnormalities in the colon. In fact, it’s the only prevention method available for colorectal cancer. However, there are different x-rays that can evaluate the colon, including a barium enema and virtual CT scan. These are, however, only diagnostic exams. Treatment of abnormalities will require a colonoscopy or surgery.

In general, colonoscopy is a very safe procedure. Overall, complications occur in less than 1% of patients. Most complications are not life-threatening. However, if a complication occurs, it may require hospitalization and surgery. Prior to the exam, a consent form will be reviewed with the patient by the nursing staff. Should any questions or concerns arise, these can be discussed with your physician prior to beginning the procedure.

Medication reactions associated with the sedation can occur. These can include, but are not limited to, allergic reactions, difficulty breathing, effects on the heart and blood pressure, and irritation of the vein used to give the medication.

Bleeding can occur with biopsies and the removal of polyps. Again, significant bleeding, which might require a blood transfusion or hospitalization, is very uncommon. However, bleeding can occur at the time of the exam or up to two weeks after the exam if a polyp is removed.

Perforation or puncture of the colon can occur. This may be recognized at the time of the exam, or it may not be apparent until later in the day. In most cases, a perforation will require surgery and hospitalization. This is an uncommon complication, even when polyps are removed.

It is very important that you contact your doctor’s office immediately if symptoms arise after the procedure, such as worsening abdominal pain, bleeding, or fever.

Like any other test, a colonoscopy is not perfect. There is a small, accepted risk that abnormalities, including polyps and cancers, can be missed at the time of the exam. It is important to continue to follow up with your doctor at GI Alliance as instructed and inform them of any new or persistent symptoms.