Procedure

The colon, or large intestine, is the last portion of your digestive or gastrointestinal (GI) tract. It starts at the cecum, which attaches to the end of the small intestine. The colon consists of a hollow tube about five feet long that absorbs water and minerals from digested food. It contains the rectum, which stores undigested solid waste.

The term colonoscopy refers to a medical procedure during which a long flexible tube is used to look inside the colon. It is a procedure performed by a gastroenterologist, a well-trained specialist.

The main instrument that is used to look inside the colon is the colonoscope. The colonoscope is a long, thin, flexible tube with a tiny video camera and a light on the end. By adjusting the various controls on the colonoscope, the gastroenterologist can carefully guide the instrument in any direction to look at the inside of the colon. The high-quality picture from the colonoscope is shown on a TV monitor, and gives a clear, detailed view.
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The endoscope does not cause problems with breathing unless you have lung or heart problems

Before the Procedure

Regardless of why ERCP has been recommended for you, there are important steps you can To properly prepare for your procedure, you may need to make certain changes to your daily medication routine.

• If you take insulin or diabetic tablets, consult with your physician about making any necessary changes in you daily regimen.
• You must tell your doctor what drugs you are taking, particularly: Aspirin products, Arthritis drugs, Blood thinners eg. Warfarin (anticoagulants). It may be necessary to stop taking them seven days before your procedure. They may increase your risk of bleeding after removal of a polyp or a biopsy during your upper GI endoscopy by interfering with the normal clotting of your blood. IF YOU ARE TAKING COUMADIN OR HEPARIN, YOU MUST CHECK WITH YOUR PRESCRIBING PHYSICIAN BEFORE CHANGING OR INTERRUPTING YOUR DAILY ROUTINE.
• Certain medications should be continued prior to your upper GI endoscopy. If you take cardiac (heart) or anti-hypertensive (high blood pressure) pills, take them as you normally do with small sips of water.

In addition to changes to your medication, you'll also need to:

• Bring a list of all your medications (prescription medications, over-the-counter medications and eye drops) with you on the day of your procedure. You may bring the medication bottles themselves.
• Be prepared to list and describe your ALLERGIES and REACTIONS to any medications.
• Take some medications to cleanse your bowel.

Tell the doctor if you have: a pacemaker, a joint replacement, heart, lung or other medical conditions that may need special attention .
Tell your doctor if you have to take antibiotics before dental treatment. If so, you may also need antibiotics before an upper endoscopy

Because you will receive a relaxing medication during your procedure, you must arrange to have a responsible adult pick you up and/or accompany you home if you taking public transportation. You may not operate an automobile or other mechanical equipment until the day following your procedure.

Preparation for the Procedure

You will be given instructions in advance that will outline what you should and should not do in preparation for colonoscopy; be sure to read and follow these instructions. One very critical step is to thoroughly clean out the colon, which, for many patients, can be the most trying part of the entire exam. It is essential that you complete this step carefully, because how well the bowel is emptied will help determine how well your doctor can examine it during colonoscopy.

Various methods can be used to help cleanse the bowel, and your doctor will recommend what he or she prefers in your specific case. Often, a liquid preparation designed to stimulate bowel movements is given by mouth. Additional approaches include special diets, such as clear fluids, or the use of enemas or suppositories. Whichever method or combination of methods is recommended for you, be sure to follow instructions as directed.

Check your instructions about what to eat or drink the night before your colonoscopy and when to stop eating. Consult your doctor prior to the procedure to determine if the medications you are on should be taken or not prior to the colonoscopy.

But generally following instructions apply:

On the day before the procedure, starting at noon, do not eat solid food until the procedure is completed. Drink clear liquids only.

• Between 5:00 and 7:00 PM, start drinking a large glass of bowel cleanising solution every 10 minutes.

If you feel full or experience nausea or significant abdominal pain, wait before drinking the next glass. It may be easier to drink each glass rapidly rather than drinking small amounts continuously. Drink the entire volume of fluid. You should begin having bowel movements within the hour. Then continue drinking lemon water or cold drinks or clear liquids till the procedure.
DO NOT DRINK ANYTHING RED OR ORANGE.

• On the day of your colonoscopy, please come directly to the requested location at your scheduled arrival time and check in with the receptionist. Plan to spend several hours at the unit to allow time for your preparation, your procedure, and your recovery.
• Before the procedure, a nurse will greet you and assist you with changing into a hospital gown. An IV will be placed in your arm. You will receive relaxing medications through the IV during the procedure.

During the Procedure

During the procedure, everything will be done to ensure that you will be as comfortable as possible. An intravenous line, or IV, will be placed to give you medication to make you relaxed and drowsy. The drug may enable you to remain awake and cooperative while preventing you from remembering much of the experience.

Once you are fully relaxed, your doctor will first do a rectal exam with a gloved, lubricated finger; then the lubricated colonoscope will be gently inserted.

As the scope is slowly and carefully passed, you may feel as if you need to move your bowels, and because air is introduced to help advance the scope, you may feel some cramping or fullness. Generally, however, there is little or no discomfort.

The time needed for colonoscopy will vary, depending in part on what is found and what is done; the procedure itself usually takes anywhere from 15 to 60 minutes .Afterwards, you will be cared for in a recovery area until most of the effects of the medication have worn off. At this time, your doctor will inform you about the results of your colonoscopy and provide any additional information you need to know. You will also be given instructions regarding how soon you can eat and drink, plus other guidelines for resuming your normal routine.

Risks of this Procedure

• Although colonoscopy is a safe procedure, complications can occur, including perforation or puncture of the colon walls, which could require surgical repair. Complications during a colonoscopy are rare.
• The procedure may not be able to be completed due to bowel disease or other problems. Polyps or cancer can be missed. The risks of this happening are higher if your bowel is not well prepared. It is important that you follow the instructions to clear your bowel before the procedure.
• When polyp removal or biopsy is performed, hemorrhage — heavy bleeding — may result and sometimes require blood transfusion or reinsertion of the colonoscope to control the bleeding.
• The risk may be greater the larger the polyp. Sometimes bleeding can happen up to 12 days afterwards. This usually settles without further treatment.
• Mild pain and discomfort in the abdomen for one or two days after the procedure. This is treated with pain relief. It usually settles without further treatment.

Very rarely, heart and lung problems such as:

• low oxygen levels
• lowered blood pressure
• higher pulse rate
• pneumonia (caused by vomit going down the lungs)

People with ill health are more at risk. Healthy people may feel very drowsy for a few days afterwards. The procedure is immediately stopped if anything happens. Rarely, drugs may be given to take away the effects of the sedation and at worse life saving procedures may be needed.

Death due to complications of colonoscopy is extremely rare.

Be sure to discuss any specific concerns you may have about the procedure with your doctor.

After the Procedure

When your colonoscopy is completed you will be cared for in a recovery area until most of the effects of the medication have worn off.

When your colonoscopy is completed on an outpatient basis, you will need to remain under observation until your doctor or healthcare team has decided you can return home. Sometimes, admission to the hospital is necessary.
Occasionally, minor problems may persist, such as bloating, gas or mild cramping, which should disappear in 24 hours or less.

For your safety you must:

• Be taken home by a responsible person
• Have a responsible adult care for you that day/night or be on hand in case of any problems
• Not drive a car or motorcycle (this is against the law) or operate machinery until the following day or for as long as your doctor or anaesthetist advises
• Not make any important decisions or sign any contracts within 24 hours of the procedure (the medication used may impair judgement)
• Not drink any alcohol for 24 hours post procedure

Tell your doctor immediately if you:

• Feel generally ill with or without headache, chills or muscle aches
• Have a high temperature/fever
• Have trouble swallowing or severe abdominal pain
• Are dizzy, short of breath or feel faint or dizzy
• Start to get sharp pains in the throat, chest or stomach or begin vomiting

Your doctor will explain the results of the examination to you or arrange for you to come back to hospital and talk to you about the results.