Colonoscopy

Colonoscopy is an essential medical procedure that can save your life. The early detection of precancerous lesions or other conditions of the large intestine (colon) and rectum is crucial for successful treatment. We invite you to learn in detail what this investigation involves, when it is necessary, and how you can prepare for it. 

What is a Colonoscopy? 

Colonoscopy is an endoscopic procedure that allows the doctor to examine the inner lining of your entire large intestine (colon) and, typically, the final portion of the small intestine (the terminal ileum). 

The procedure is performed using a flexible instrument called a colonoscope, which is equipped with a light source and a high-performance video camera. This instrument is inserted through the rectum and slowly advanced along the colon. High-resolution images are transmitted to a monitor, allowing the doctor to identify any anomalies: inflammation, ulcers, bleeding, or, most importantly, polyps. 

The primary goal of a colonoscopy is to detect and often remove polyps (benign growths that can transform into colorectal cancer). Although it is an internal procedure, it is considered minimally invasive and is usually performed under sedation to ensure your comfort. 

Understanding the procedure will help eliminate any fears so you can approach the investigation with confidence. 

When is a Colonoscopy Recommended? 

The recommendation to perform a colonoscopy comes from a gastroenterologist and is based on international medical guidelines, your specific symptoms, or your family medical history. 

1. Routine Screening for Colorectal Cancer

• Standard Age: If you are at average risk (no symptoms and no family history), the first screening colonoscopy is recommended starting at age 45. 

• Frequency: In the absence of any abnormal findings, the next investigation may be necessary after an interval of 5 to 10 years. 

2. Investigating Digestive Symptoms Your doctor may recommend a colonoscopy if you present with the following persistent signs or symptoms:

• Rectal bleeding or presence of blood in the stool. 

• Unexplained changes in bowel habits (new and persistent diarrhea or constipation). 

• Chronic abdominal pain. 

• Iron-deficiency anemia (low iron) without an obvious cause. 

• Unexplained weight loss. 

3. Monitoring Existing Conditions If you have already been diagnosed with certain diseases (such as Crohn’s disease or Ulcerative Colitis) or if you have had polyps in the past, colonoscopy is a vital tool for monitoring the progression of the disease and preventing recurrence.

Advantages of Colonoscopy 

Colonoscopy is considered the “Gold Standard” in colon examination due to its unique advantages: 

• Dual Role: Diagnostic and Therapeutic. It not only identifies problems but also allows for immediate treatment (e.g., removing polyps in the same session – polypectomy). 

• Colorectal Cancer Prevention. It is the most effective method of prevention because polyps can be removed before they become malignant. 

• Direct and Complete Visualization. It offers the doctor a high-resolution view of the entire mucosa, detecting lesions that other tests might miss. 

• Precise Biopsy. It allows for the collection of tissue samples (biopsies) from suspicious areas, which are necessary for an exact histological diagnostic. 

• Sedation (On Request). It ensures a comfortable procedure, without pain or significant discomfort, contrary to general perception. 

Conditions Diagnosed via Colonoscopy 

Colonoscopy is an extremely versatile diagnostic tool capable of identifying a wide range of health issues in the large intestine and rectum: 

• Colorectal Cancer: Malignant tumors in early or advanced stages. 

• Colorectal Polyps: Benign growths (adenomas) that are precursors to cancer. 

• Inflammatory Bowel Diseases (IBD): 

• Ulcerative Colitis: Chronic inflammation affecting the rectum and usually extending to the entire colon. 

• Crohn’s Disease: Chronic inflammation that can affect any part of the digestive tract but often includes the colon. 

• Diverticulosis/Diverticulitis: Small pouches, called diverticula, that form in the colon wall and can become inflamed. 

• Angiodysplasia: Vascular lesions that can cause bleeding. 

• Ischemic Colitis: Inflammation of the colon caused by reduced blood flow. 

• Causes of Lower Gastrointestinal Bleeding: Internal hemorrhoids, fissures, or ulcers. 

Types of Colonoscopy 

There are several approaches, but the most common and comprehensive remains the conventional colonoscopy. 

Standard Colonoscopy (Conventional) This is the procedure described above, using a flexible colonoscope under medical supervision. It is the most complete type of examination, offering the possibility of intervention (polypectomy, biopsy) during the investigation. 

Virtual Colonoscopy (CT Colonography) Virtual Colonoscopy is a non-invasive method that uses a high-resolution CT scanner to create detailed 3D images of your colon. Although it does not require the insertion of an endoscope, the procedure implies the same rigorous bowel preparation as standard colonoscopy. It requires a small tube inserted into the rectum to inflate the colon with air or carbon dioxide (CO2). However, you must know that this method is strictly diagnostic. If polyps or suspicious lesions are found, a subsequent conventional colonoscopy will be required to remove them or take biopsies. 

Flexible Sigmoidoscopy Flexible sigmoidoscopy is similar to standard colonoscopy but examines only the rectum and the lower part of the colon (sigmoid colon). This procedure is usually faster and requires simpler preparation. However, consider its main limitation: because it does not examine the entire colon, there is a risk of missing lesions located in the upper portions (such as the transverse or ascending colon). 

Preparing for Colonoscopy 

The success and accuracy of the colonoscopy depend largely on how well you prepare. Correct preparation ensures that the inside of your colon is completely clean, allowing the doctor to clearly visualize the lining and not miss any small lesions. 

Preparation includes two key stages: 

1. Diet (A Few Days Before)

• 4-5 days prior: Begin avoiding foods high in fiber, seeds, nuts, and whole grains. These can persist in the intestine and obstruct the view. 

• The day before: Switch to a strict clear liquid diet. You may consume water, plain tea, strained broth (without vegetables, meat, or noodles), apple or white grape juice, and clear sports drinks. Milk and any red or purple liquids are prohibited. 

2. The Cleaning Solution (Bowel Prep)

• Strict Instructions: The doctor will prescribe a strong laxative solution (usually polyethylene glycol-based) that you must consume according to a precise protocol, typically split into two doses (the evening before and the morning of the procedure). 

• Hydration is Essential: Throughout the preparation, it is vital to stay hydrated with clear liquids to prevent dehydration. 

Note: If you take anticoagulant medication (blood thinners) or iron supplements, it is crucial to discuss this with your doctor at least one week in advance, as you may need to temporarily stop them. 

How the Colonoscopy is Performed 

The procedure itself generally takes between 30 and 60 minutes and is performed by a specialized gastroenterologist. 

• Sedation (A choice for your comfort): Most often, mild sedation (analgosedation) is administered intravenously. This will keep you relaxed and drowsy throughout the procedure, eliminating discomfort. 

• Positioning: You will be placed on the examination bed, usually on your left side, with knees slightly bent. 

• Insertion: The doctor carefully introduces the lubricated colonoscope through the rectum and slowly advances it through the colon. 

• Examination: To facilitate visualization, air or carbon dioxide (which causes less discomfort) is introduced into the colon to expand the walls. The doctor inspects the lining as the scope advances. 

• Polypectomy and Biopsy: If polyps are detected, they are usually removed immediately using special instruments passed through the colonoscope’s working channel (polypectomy). Any suspicious area is biopsied. 

• Withdrawal: Once the end of the colon (or terminal ileum) is reached, the colonoscope is slowly withdrawn, and the doctor examines the lining again to ensure no lesion is missed. 

After the Procedure 

Since the procedure is most often performed under sedation, you will spend a short time in the recovery area under monitoring until the effect of the sedative wears off. 

• Initial Recovery: It is normal to feel drowsy or dizzy. 

• Mild Effects: You may feel slight cramps or a sensation of bloating due to the air remaining in the colon. These symptoms improve rapidly as you pass gas. 

• Rehydration and Diet: You can resume your usual diet, starting with light meals. It is important to hydrate well. 

• Driving Restrictions: You must be accompanied and must not drive for 12-24 hours after a colonoscopy performed under sedation, as your reflexes and judgment may be impaired. 

The Results 

The doctor will provide you with a preliminary result immediately after the procedure, informing you about the general appearance of the colon, whether polyps were found, and if they were removed. 

However, the final histopathological report takes more time. If biopsies were taken or polyps removed, they will be sent to a laboratory where a pathologist will examine the tissue under a microscope to determine if the lesions are benign, precancerous, or malignant. This final result is available usually in 7-14 days and is crucial for establishing the treatment plan or the optimal interval for the next surveillance colonoscopy. 

Risks and Complications 

Colonoscopy is a safe procedure, but like any medical investigation, it involves minor risks. It is important to know that the rate of major complications is very low (less than 1 in 1,000 procedures). 

The rarest, but serious, complications include: 

• Colonic Perforation: A tear in the colon wall, a medical emergency requiring surgery. The risk increases slightly with complex polypectomies. 

• Hemorrhage: Bleeding at the biopsy or polypectomy site. Usually, the bleeding is minor and stops on its own, but sometimes it may require additional treatment (endoscopic cauterization) or, rarely, a transfusion. 

• Adverse Reactions to Sedation: Allergic reactions or cardio-respiratory issues. These are rare due to constant monitoring by the medical team. 

Important: If you experience severe abdominal pain, fever, heavy rectal bleeding, or persistent dizziness after the procedure, contact your doctor immediately. 

It’s Time to Take Care of Your Digestive Health 

Do not delay an investigation that can save your life. Whether you have symptoms or have reached the recommended screening age, a timely colonoscopy gives you the peace of mind you need. 

Book your colonoscopy appointment NOW!