Colonoscopy ( ) or coloscopy ( ) is an endoscopic examination of the colon and the distal portion of the small intestine with a CCD camera or a fiber optic camera on a flexible tube through the anus. This can provide a visual diagnosis (eg, ulceration, polyp) and provide opportunities for biopsy or removal of suspected colorectal cancer lesions. Colonoscopy can remove polyps as small as a millimeter or less. Once the polyps are removed, they can be studied with the help of a microscope to determine if they are precancerous or not. It takes up to 15 years for the polyp to turn into cancer.
Colonoscopy is similar to sigmoidoscopy - a difference related to which part of the colon can be examined. Colonoscopy allows examination of entire colon (length 1200-1500 mm). Sigmoidoscopy allows examination of the distal (about 600 mm) portion of the colon, which may be sufficient as the benefits for survival of colonoscopy cancer have been limited to detection of lesions in the distal portion of the colon.
Sigmoidoscopy is often used as a screening procedure for full colonoscopy, often performed simultaneously with fecal occult blood test (FOEC). About 5% of these screened patients are referred to colonoscopy.
A virtual colonoscopy, which uses 2D and 3D images reconstructed from computed tomography (CT) scans or from nuclear magnetic resonance scanning (MR), is also possible, as a completely non-invasive medical test, though not standardized and still under investigation with regard to its diagnostic ability. Furthermore, virtual colonoscopy does not allow for therapeutic maneuvers such as removal of polyps/tumors or biopsy or visualization of lesions smaller than 5 millimeters. If growth or polyps are detected using CT colonography, standard colonoscopy still needs to be done. In addition, surgeons have recently used the term pouchoscopy to refer to colonoscopy in ileo-anal pouches.
Video Colonoscopy
Medical use
Conditions that require colonoscopy include gastrointestinal bleeding, unexplained changes in bowel habits and alleged malignancy. Colonoscopies are often used to diagnose colon cancer, but are also often used to diagnose inflammatory bowel disease. In older patients (sometimes even younger ones) an unexplained hematocrit reduction (one of the signs of anemia) is an indication that requires colonoscopy, usually together with esophagogastroduodenoscopy (EGD), even if no blood is seen in the stool dirt).
The fecal occult blood is a quick test that can be done to test the microscopic traces of blood in the stool. Positive tests are almost always an indication for colonoscopy. In many cases, positive results are only due to hemorrhoids; However, it can also be caused by diverticulosis, inflammatory bowel disease (Crohn's disease, ulcerative colitis), colon cancer, or polyps. However colon polypectomy has become a routine part of colonoscopy, allowing for the removal of polyps quickly and simply without invasive surgery.
colon cancer screening
Colonoscopy is one of the colorectal cancer screening tests available to people in the US over the age of 50. Other screening tests include flexible sigmoidoscopy, double-contrast barium enema, computed tomography (CT) colongraphy, guaiac-based fecal occult blood test (gFOBT), faecal immunochemistry (FIT), and stool multidarget fecal screening tests. Cologuard).
Subsequent screening is then scheduled based on preliminary findings, with five or ten years of retention common to colonoscopies that produce normal results. People with a family history of colon cancer are often first screened during their adolescence. Among people who had early colonoscopy who did not find polyps, the risk of developing colorectal cancer within five years was very low. Therefore, it is not necessary for people to have another colonoscopy sooner than five years after the first screening.
The medical community recommends screening colonoscopy every 10 years starting at age 50 for adults without an increased risk for colorectal cancer. Research shows that cancer risk is low for 10 years if high-quality colonoscopy does not detect cancer, so tests for this purpose are indicated every ten years.
Screening of colonoscopy prevents about two thirds of deaths from colorectal cancer on the left side of the colon, and is not associated with a significant reduction in deaths from right-sided disease.
Colonoscopy reduces cancer rates by detecting some colon polyps and cancers on the left side of the colon early enough so they can be treated, and a smaller number on the right side; much of this left-sided growth will also be detected by safer sigmoidoscopy procedures.
Because polyps often take 10 to 15 years to turn into cancer, in someone with an average risk of colorectal cancer, the guidelines recommend 10 years after normal colonoscopy screening before the next colonoscopy. (This interval does not apply to people at high risk of colorectal cancer, or those with colorectal cancer symptoms.)
Recommendations
The American Cancer Society recommends, starting at age 50, both men and women follow one of the testing schedules for screening to find intestinal polyps and/or cancers:
- Flexible sigmoidoscopy every 5 years, or
- Colonoscopy every 10 years, or
- Double contrast barium enema every 5 years, or
- CT colonography (virtual colonoscopy) every 5 years
- The annual blood test of annual occult guayapa (gFOBT)
- Annual immunochemical stool test (FIT)
- DNA stool (sDNA) test every 3 years
Medicare Coverage
In the United States, Medicare insurance includes the following colorectal screening tests:
- Colonoscopy: average risk - every 10 years starting at age 50, high risk - every 2 years with no age limit
- Flexible sigmoidoscopy - every 4 years starting from age 50
- Double contrast barium enema: average risk - every 4 years from 50 years of age, high risk - every 2 years
- (CT) colongraphy: not covered by Medicare
- gFOBT: average risk - every year starting at age 50
- FIT: average risk - every year starting at 50
- Cologuard: average risk - every 3 years starting from age 50
Maps Colonoscopy
Risk
About 1 in 200 people undergoing colonoscopy experience serious complications. Colon perforation occurs in about 1 in the 2000 procedure, bleeding 2.6 per 1,000, and death in 3 per 100,000.
Therefore, in some low-risk populations, screening in the absence of symptoms will not exceed the risk of the procedure. For example, the possibility of developing colorectal cancer between the ages of 20 and 40 is only 1 in 1250. This procedure has a low risk of serious complications (0.35%).
The degree of complications varies with the practitioners and institutions performing the procedure, as well as the function of other variables.
Perforation
The most serious complications are generally gastrointestinal perforations, which are life-threatening and in many cases require major surgery for immediate repair. Less than 20% of cases can be successfully managed with a conservative (non-surgical) approach.
The 2003 relative risk analysis of sigmoidoscopy and colonoscopy, drew attention that the risk of perforation after colonoscopy was approximately doubled after sigmoidoscopy (consistent with the fact that the colonoscopy examined the longer portion of the colon), although this difference seems to be decreasing.
Bleeding
Bleeding complications can be treated immediately during the procedure by cauterization through the instrument. Delayed bleeding may also occur at the polyp release site for up to a week after repeat procedures and procedures can then be performed to treat the bleeding site. Even more rarely, splenic rupture can occur after colonoscopy because of the attachment between the colon and the spleen.
Anesthesia
As with any procedure involving anesthesia, other complications include cardiopulmonary complications such as a temporary decrease in blood pressure, and oxygen saturation is usually due to overmedication, and easily reversed. Anesthesia can also increase the risk of blood clots formation and cause pulmonary embolism or deep vein thrombosis. (DVT) In rare cases, more serious cardiopulmonary events such as heart attack, stroke, or even death may occur; this is very rare except in critically ill patients with various risk factors. In very rare cases, coma associated with anesthesia may occur.
Bowel preparation
Dehydration caused by laxatives usually given during colon preparation for colonoscopy may also occur. Therefore, patients should drink large amounts of fluid during the days of colonoscopy preparation to prevent dehydration. Loss of electrolytes or dehydration is a potential risk that can even be proven to be lethal. In rare cases, severe dehydration can cause kidney damage or renal dysfunction in the form of phosphate nephropathy.
More
Virtual colonoscopy carries risks associated with radiation exposure.
Colonoscopy preparation and colonoscopy procedures can cause colitis and diarrhea or intestinal obstruction.
During colonoscopies in which polyps are removed (polypectomy), the risk of complications has been higher, though still very rare, around 2.3 percent. One of the most serious complications that may arise after colonoscopy is postpolypectomy syndrome. This syndrome occurs because of the potential burns to the intestinal wall when the polyp is removed. However, complications are very rare and as a result, people may experience fever and abdominal pain. This condition is treated with intravenous fluids and antibiotics.
Colonic infections are a potential risk of colonoscopy, although very rare. The large intestine is not a sterile environment because many bacteria live in the colon to ensure proper bowel function and therefore the risk of infection is very low. Infections may occur during biopsy when too much tissue is removed and bacteria stand out in areas that are not theirs or in cases where the lining of the large intestine and bacteria enter the abdominal cavity. Infection can also be transmitted between patients if the colonoscope is not cleared and properly sterilized between tests.
The risk of minor colonoscopy may include nausea, vomiting or allergies in the sedative used. If the drug is given intravenously, the vein may become irritated. Most local irritations in the veins leave soft bumps lasting several days but eventually disappear. The incidence of this complication is less than 1%.
On very rare occasions, intracolonic explosions can occur. Careful bowel preparation is the key to preventing this complication.
Signs of complications include severe abdominal pain, fever and chills, or rectal bleeding (more than half a cup or 100mL).
Procedures
Get started
The colon must be free of solids in order for the test to be performed properly. For one to three days, patients are asked to follow a diet low in fiber or clear liquid only. Examples of clear liquid are apple juice, chicken broth and/or beef or broth, lemon-lime soda, lemonade, sports drinks, and water. It is important that the patient remains hydrated. Sports drinks contain electrolyte that runs out during colon cleansing. Orange juice, prune juice and fiber-containing milk should not be consumed, nor should they be dyed red, purple, orange, or sometimes brown; however, cola is allowed. In most cases, tea (no milk) or black coffee (no milk) is allowed.
The day before the colonoscopy, the patient is given a laxative preparation (such as Picosalax, Bisacodyl, phospho soda, sodium picosulfate, or sodium phosphate and/or magnesium citrate) and large amounts of fluid, or irrigation of the entire intestine is carried out using polyethylene glycol and electrolyte solutions. Often, this procedure involves pill form laxatives and the preparation of intestinal irrigation with polyethylene glycol powder dissolved into clear fluids, preferably sports drinks containing electrolytes.
The general procedure used is as follows: In the morning before the procedure, a 238 gram polyethylene glycol powder bottle should be poured into 64 oz. (1.9 liters) of selected clear liquid, which must then be mixed and cooled. Two (2) bisaccodyl 5 mg tablets taken at 3 pm; at 5 pm, the patient starts drinking a mixture (about 8 oz. (0.5 liters) every 15-30 minutes to complete); at 8 pm, take two (2) bisacodyl 5 mg tablets; continue to drink/hydrating into the night until sleep with permitted fluids. The common bisacodyl brand name is Dulcolax, and the store brand is available. The common brand name of polyethylene glycol powder is MiraLAX. It may be advisable to schedule an earlier procedure on a particular day so that the patient does not have to leave without food and only limited fluid in the morning from the above procedure must go through the previous preparation procedure the previous day.
Since the purpose of the preparation is to clean the colon solids, patients should plan to spend the day at home in a comfortable environment with ready access to toilet facilities. The patient may also want to use a wet towel or bidet to clean the anus. Soothing ointments such as petroleum jelly applied after cleaning the anus will improve patient comfort.
Patients may be asked to skip aspirin and products such as aspirin such as salicylates, ibuprofen, and similar drugs up to ten days before the procedure to avoid the risk of bleeding if polypectomy is performed during the procedure. Blood tests may be performed before the procedure.
Several hospitals and clinics have begun using techniques used in colon hydrotherapy as an alternative to the standard preparatory methods described above. In this case, special equipment is used to clean the intestines of patients with warm water, shortly before the colonoscopy procedure, to remove intestinal contents. This relieves the patient from having to swallow large amounts of fluid, or at risk of nausea, vomiting, or anal irritation. The time required for overall preparation decreases significantly, which often facilitates easier scheduling of procedures.
Investigation
During the procedure, patients are often given intravenous sedation, using agents such as fentanyl or midazolam. Although meperidine (Demerol) can be used as an alternative to fentanyl, worrisome seizures have lowered this agent to a second choice for sedation behind the combination of fentanyl and midazolam. The average person will receive a combination of these two drugs, usually between 25 and 100 Ã,Âμg IV fentanyl and 1-4Ã, mg IV midazolam. The practice of sedation varies between practitioners and the state; in some clinics in Norway, sedation is rarely given.
Some endoscopists are experimenting with, or routinely using, alternative or additional methods such as nitrous oxide and propofol, which have advantages and disadvantages associated with recovery time (especially the duration of amnesia after the procedure is completed), patient experience, and the degree of supervision required for administration safety. This sedation is called "twilight anesthesia". For some patients it is not fully effective, so they are completely awake for the procedure and can see the inside of their colon on a color monitor. Replace propofol for midazolam, which gives patients faster recovery, gaining wider use, but requires more strict breathing monitoring.
A meta-analysis found that playing music improves the patient's tolerability of the procedure.
The first step is usually the rectal examination, to check the sphincter tone and to determine if the preparation is adequate. The endoscope is then passed through the anus into the rectum, the colon (sigmoid, descending, transverse and ascending colon, cecum), and finally the ileal terminal. The endoscope has a moving end and several channels for instrumentation, air, suction and light. The gut is sometimes disassembled with air to maximize visibility (a procedure that gives one the false sensation necessary to take bowel movement). Biopsy is often taken for histology. Also in a procedure known as chromoendoscopy, contrast-dyes (such as Indigo carmine) can be sprayed through the endoscope into the intestinal wall to help visualize any abnormalities in mucosal morphology. The updated Cochrane review in 2016 found strong evidence that Chromoscopy improves detection of cancer tumors in the colon and rectum.
In the most experienced hands, the endoscope is advanced to the intersection where the colon and small intestine join (cecum) in less than 10 minutes in 95% of cases. Due to the narrow curves and redundancy in the non-fixed colon area, loops can form where the endoscopic advances create a "bending" effect that causes the tip to be really interesting. These loops often cause discomfort due to the stretching of the colon and mesentery associated. Maneuvers to "reduce" or release loops include pulling the back endoscope while igniting the instrument. Alternatively, body position changes and stomach support from external hand pressure can often "straighten" the endoscope to allow the scope to move forward. In a small percentage of patients, iteration is often referred to as the cause of incomplete examination. The use of alternative instruments leading to completion of examination has been investigated, including the use of pediatric colonoscopy, thrust enteroscopy, and upper GI endoscopic variants.
For screening purposes, closer visual examination is then often performed on endoscopic withdrawal for 20 to 25 minutes. The recent lawsuits over missing cancer lesions prompted some agencies to better document the withdrawal time as fast withdrawal time could be a potential source of medical legal obligations. This is often a real concern in clinical settings where a high case burden can provide a financial incentive to complete the colonoscopy as quickly as possible.
Suspicious lesions may be dried, treated with laser light or cut with electric wire for biopsy purposes or complete removal polypectomy. Drugs can be injected, eg. to control bloody lesions. On average, this procedure takes 20-30 minutes, depending on the indications and findings. With some polypectomies or biopsies, the procedure time may take longer. As mentioned above, anatomical considerations may also affect the timing of the procedure.
After the procedure, some recovery time is usually allowed to let the tranquilizer disappear. Outpatient recovery times can take an estimated 30-60 minutes. Most facilities require patients to bring someone to help them return afterwards (again, depending on the sedation method used).
One of the most common side effects of the procedure is an abdominal bloating and small wind pain caused by air insufflation to the colon during the procedure.
The advantage of colonoscopy against x-ray imaging or other less invasive tests, is the ability to perform therapeutic interventions during the test. Polyps are the growth of excess tissue that can develop into cancer. If a polyp is found, for example, it can be removed by one of several techniques. The meshes device can be placed around the polyp to be removed. Even if the polyp is flat on the surface, it can often be removed. For example, the following shows the polyp removed gradually:
Pain Management
The pain associated with this procedure is not caused by insertion of the scope but by the inflation of the colon to perform the examination. The scope itself is essentially a long, flexible tube of one centimeter in diameter, that is as big as a pinkie, which is smaller than the average stool diameter.
The large intestine is wrinkled and wavy, somewhat like an accordion or a dryer-dryer drying tube, which provides the large surface area required for water absorption. To examine this surface thoroughly, doctors blow it like a balloon, using an air compressor, to remove wrinkles. The stomach, the intestine, and the colon have what are called "second brains" wrapped around them, which autonomously run a digestive chemical plant. Using complex hormonal signals and nerve signals to communicate with the brain and the rest of the body. Usually the task of the colon is to digest food and regulate intestinal flora. Dangerous bacteria in rancid foods, for example, produce gas. The colon has a distensi sensor that can tell when an unexpected gas pushes the outgoing wall of the colon - so the "second brain" tells the person that he has intestinal difficulties by feeling nauseated. Doctors usually recommend total anesthesia or partial partial tranquilizers either to inhibit or reduce the patient's awareness of pain or discomfort, or just the unusual sensation of the procedure. After the colon increases, the doctor will examine it with scope as it is slowly pulled back. If any polyps are found they are then cut for later biopsies.
Some doctors prefer to work with patients who are completely anesthetized because of the lack of pain or discomfort felt to allow for casual examination. Twilight sedation, however, is inherently safer than general anesthesia; it also allows the patient to follow simple commands and even to view the procedure on a closed-circuit monitor. Tens of millions of adults each year need to have a colonoscopy, but many are not due to concerns about the procedure.
It should be noted that in many hospitals (eg St. Mark's Hospital, London, specializing in colon and colorectal medicine), colonoscopy is performed without sedation. This allows the patient to change his posture to help the doctor perform the procedure and significantly reduce recovery time and side effects. Although there are some discomforts when the large intestine is swollen with air, this usually does not hurt and runs relatively quickly. Patients can then be excluded from the hospital themselves very quickly without any feeling of nausea.
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Duodenography and colonography are performed like standard abdominal examinations using B-mode and Doppler ultrasonographic color flows using low frequency transducers - eg 2.5 MHz - and high frequency transducers, eg 7.5 MHz probes. Detailed examination of the duodenal wall and folds, colon and haustral walls were performed using a 7.5 MHz probe. The deep abdominal structure is examined using a 2.5 MHz probe. All ultrasound examinations performed after overnight fasting (at least 16 hours) using standard scanning procedures. Subjects checked with and without water contrast. Water contrast imaging is done with adult subjects taking at least one liter of water before the examination. The patient is examined in the supine, left posterior oblique position, and the left lateral decubitus position using the intercostal and subcostal approaches. Liver, gallbladder, spleen, pancreas, duodenum, colon, and kidney are routinely evaluated in all patients. With the patient lying on his back, a duodenal examination with high-frequency duodenal ultrasound was performed with a 7.5 MHz examination placed in the upper right abdomen, and central epigastricities respectively; for high-frequency ultrasound colonies, ascending colon, is examined with a starting point usually in the center of an imaginary line flowing from the iliac crest to the umbilicus and progressing to the cephalid through the right middle abdomen; for the descending colon, the examination starts from the upper left abdomen that runs caudally and crosses the left middle abdomen and leaves the lower abdomen, ending in the sigmoid colon in the lower pelvic region. Sonography Doppler color flow is used to examine the localization of lesions in relation to blood vessels. All measurements of wall diameter and thickness are done with built-in software. Measurements were taken between peristaltic waves.
Economy
Researchers have found that older patients with three or more significant health problems, such as dementia or heart failure, have high rates of recurrent colonoscopy without medical indications. These patients tend to live long enough to develop colon cancer. Gordon stated, "At about $ 1,000 per procedure, there is clearly an economic incentive".
The Hemoccult II FOBT (combined with follow-up colonoscopy if indicated by the test) is more than 5 times as cost effective as other screening strategies, but only about 85% as sensitive. Due to its relatively low sensitivity, US guidelines recommend a higher procedure 5 times more expensive, because even a relatively small increase in life-saving and a 5-fold cost increase is seen as a viable option, given the US standard of living.
History
In 1960, Dr. Niwa and Dr. Yamagata at the University of Tokyo developed this tool. After 1968, Dr. William Wolff and Dr. Hiromi Shinya pioneered the development of colonoscope. Their discovery, in 1969 in Japan, is an advance over the barium enema and flexible sigmoidoscope as it allows the visualization and removal of polyps from throughout the colon. Wolff and Shinya advocate their findings and publish much of the initial evidence necessary to overcome the skepticism about the safety and efficacy of the device. Colonoscopy with CCD invention and market is led by film Fuji, Olympus and Hoya in Japan. In 1982, Dr. Lawrence Kaplan from Aspen Medical Group at St. Paul, MN reported a series of 100 top colonoscopies and endoscopies performed at free-standing clinics from nearby hospitals, demonstrating the safety and cost-effectiveness of this outpatient procedure.. (Personal Communication to the Joint Commission for Ambulatory Care, May 1983)
Etymology
The term colonoscopy or coloscopy comes from the ancient Greek noun ?????, the same as the English intestine , and the verbs ??? see, login to , check . The term colonoscopy is however bad, because this form presupposes that the first part of the compound consists of the possibility of root ???? v- or ???? v-, with vocal connector-so, not root ??? - from ?????. Compounds like ??????????, like hills , (with extra -on-) are derived from the ancient Greek word ?????? or ???????, hill . Similarly, colonoscopy (in addition to -on-) can literally be translated as hill examination, rather than examination of the colon .
In English, some words come from, such as colectomy, colosentesis, colopathy, and colostomy among many others, which do not actually have the wrong additions. It should be noted that some compounds have double-inserted, such as colonopathy .
See also
- Arrows and bows
- Esophagogastroduodenoscopy
- Polypectomy
- Rectal examination
- Sigmoidoscopy
- Virtual colonoscopy
References
External links
- colonoscopy. Based on NIH public domain publication No. 02-4331, dated February 2002.
- The Patient Education Brochure. American Society for Gastrointestinal Endoscopy information
- colonoscopy app. The colonoscopy app is now available for android phones and IPhones.
- Preparing the video of the American Association of Gastroenterology of the Colonoscopy
- Travel colonoscopy and risk
- What is a Third Eye Colonoscopy? Third Eye Colonoscopy
- Colonoscopy, procedure with video Colonoscopy, procedure with video
- Polypectomy Colonoscopy, video procedure with polypectomy
- Blood in Toilet Promote awareness of cancer prevention with polyp removal
- Colonoscopy information Gupta Gastroenterology Information on colonoscopy procedures
- Colorectal Cancer Incidence and Screening - United States, 2008 and 2010 Centers for Disease Control and Prevention
- Endoscopic Full-Thickness Resection (eFTR) makes it possible to remove lesions in the colon and rectum.
Source of the article : Wikipedia
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