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Colonoscopy - Part III

Colonoscopy procedure:

Have you ever heard about Colonoscopy? Why is it done? Do you know what are the reasons ,why doctor might suggest you have a Colonoscopy and in which kind of diseases it is useful in ?
A Colonoscopy is a procedure or a test that is used for diagnosis of certain harmful diseases of large intestine.
Dr.Piyush Rajan, Gastroenterologist from Sir Ganga Ram hospital,New Delhi explains the reasons why Colonoscopy test is required and which are certain diseases that require the need for procedure of this test .
According to Dr Piyush Rajan there are four main reasons for Colonoscopy
(1) Presence of red blood in stool.This may be due to Hemorrhoids ( Piles ) or bleeding in colon, Ulcerative Colitis.
(2) Blood loss due to iron deficiency anemia
(3) Unexplained painless loose motions; chronic diarrhea
(4) Unexplained persistent abdominal pain
Colonoscopy screening is a technique wherein people above 55 years of age are diagnosed for Polyps.The large Polyps are removed during this procedure in order to prevent colon cancer.This screening Colonoscopy is still not used widely in India.

Screening Colonoscopy:
A screening colonoscopy is used to screen patients for colon cancer and related issues. This type of colonoscopy is typically called for when a patient reaches a certain age range, or if they have a family history of colon cancer.

Time for screening colonoscopy:
The procedure itself usually takes from 15 to 60 minutes, but you should plan on spending 2 to 3 hours total to account for preparation, waiting and recovery time.

Most people should get screened for colon cancer no later than age 50. If your colonoscopy doesn't find any signs of cancer, you should have the exam again every 10 years.

Persons at an average risk for screening colonoscopy:
For screening, people are considered to be at average risk if they do not have:
•A personal history of colorectal cancer or certain types of polyps.
• A family history of colorectal cancer.
•A personal history of inflammatory bowel disease (ulcerative colitis or Crohn's disease).
Cost, Availablity and personal choice are the three factors that influence the selection of Colonoscopy.
Diagnostic Colonoscopy is useful for diagnosis of Ulcerative Colitis, Solitary rectal ulcers, Polyps and Colon cancer. Nearly 40% people suffer from Hemorrhoids (Piles).Piles doesn't cause blood loss.
Reasons for blood loss are as follows:
(1) Iron deficiency anemia
(2) No proper intake of food
(3) Improper absorption of food
The following Untreated diseases can lead to further complications.
(1) Ulcerative Colitis
(2) Crohn's disease
(3) Gastrointestinal tuberculosis
If theses diseases are persistent, diagnostic Colonoscopy must be performed for their detection. Gastrointestinal tuberculosis can be treated easily with antibiotics, if detected in early stage. Colonoscopy is safe procedure and it takes about 30 minutes.
Colonoscopy is one of the easiest and accurate procedure for examination of large intestine and detection of any problem.It is an out patient (OPD) procedure and no need to admit patient to clinic or hospital.A flexible rubber like tube with camera at its tip is passed through anus in large intestine for examination.
There are two types of Colonoscopy.
(1) Diagnostic
(2) Therapeutic to correct the problem .e.g. For example removal of Polyps.
American Cancer society that 45-50 years is the best age for first time screening Colonoscopy. Afterwards at intervals as advised by your gastroenterologist.If you have Polyps then you are screened more frequently for detection of cancer.
Dr.V.K.Mishra, Gastroenterologist from Gastro-liver hospital, Kanpur (Kanpur is a major industrial capital of Uttar Pradesh, the northern state of India. This town is situated on the south bank of river Ganga,located 80 km west of Lucknow, the state capital.) there are seven reasons or signs for performing Colonoscopy.
(1) Persistent diarrhea with colic pain or without pain.The stool may be semisolid mixed with blood at its Colonoscopy shas to be repeated.
Patient may be given gown to wear.To minimise discomfort, an injection sedative drug is given.Patient is asked to lie in left lateral position with knees drown in upward position. Doctor insert colonoscope through rectum.The tube is one meter (3.3 feet)and 30 cm long and reaches up to ceacum of large intestine through colon.Air or CO2 gas is passed to inflate colon.The camera continuously send images to monitor.Still photographs are taken or video recording is done.
For therapeutical procedure the polyps are removed or bleeding is blocked. Procedure takes 20-30 minutes. Thereafter patient is kept in observation room to washout the effect of sedative drug.Patien may pass gas .There may be slight bleeding in stool within one hour to 1-2 weeks.
After Colonoscopy, patient can take liquid and can take normal diet after 4 hours .
When there is no problem in colon, it is considered a negative result and it is good news for patient.
Colonoscopy should be repeated at every 10 years after age of 50 years,at every 5 years after removal of Polyps and at every one year if there is colon cancer.
Repeating Colonoscopy for
If there are one to two small polyps of less than one cm in size , Colonoscopy should be performed after5-10 years.
If there are large number polyps of larger size of more than one cm in size , Colonoscopy should be performed every year.The very large Polyps can't
be removed not by Colonoscopy but can be cut through surgery by surgeon.

Cost of colonoscopy:
Patient is required to take doctor's appointment for Colonoscopy.The cost of colonoscopy is never explained by the doctor but it is explained by receptionist.
The cost depends on geographical locations.It varies from state to state. Even within particular state, it may vary in different cities.In a city it may vary from area to area. Nextly cost also depends on illness.If patient is having heart problem or breathing problem or intestinal bleeding, patient has to be admitted to hospital as indoor one and cost of treatment may be high. Treatment cost may be high in case of additional treatment like biopsy of tissues, removal of Polyps, blocking bleeding by hemoclip or cauterization
,dilatation of narrowed colon. In metropolitan cities cost of OPD procedure is around Rs 8000-10000. In corporate hospital it is around Rs.10000 -15000.In State capitals cities, the cost may
be Rs.6000-8000. In B grade cities it may be around Rs.4000-6000. Additional charges include cost of preparation kit which is around Rs500-1000 and cost of sedative drug or anesthesia. Histopathological investigation of biopsy
tissues will also cost extra.

Virtual colonoscopy:
There is another technique known as Virtual Colonoscopy which is combination of CT scan and MRI that gives 3-D image of colon.Its cost in nearly 30% less.Virtual colonoscopy is also known as screening CT colonoscopy .Unlike traditional colonoscopy, which requires a scope to be inserted into your rectum,and advanced through your colon,this technique
doesn't require same. Virtual colonoscopy uses a CT scan to produce hundreds of cross-sectional images of your abdominal organs.

CT colonoscopy, also known as virtual colonoscopy, uses low dose radiation CT scanning to obtain an interior view of the colon (the large intestine). This area is otherwise only seen with a more invasive procedure where the doctor inserts an colonoscope into the rectum and passes it through the entire colon.
Virtual colonoscopy is painless and comfortable:
Virtual colonoscopy has some benefits over regular colonoscopy. It is less uncomfortable and invasive. It usually does not need to include any pain medicine or anesthesia.
Colonoscopy provides healthy and productive life.The incidence of colorectal cancer is 1 out of 25 perdos.Colonoscopy reduces the chanced of colon cancer by 40% and mortality rate is 60%.
Overall, the lifetime risk of developing colorectal cancer is about 1 in 23 (4.3%) for men and 1 in 25 (4.0%) for women.Colorectal cancer is a common cancer worldwide with a majority of cases occurring in the developed countries. India has a low prevalence of colorectal cance estimated five year prevalence is 87 per 100,000 population.

Risk of complications from colonoscopy:

The American Society for Gastrointestinal Endoscopy estimates that only three in 1,000 colonoscopies(0.3%) leads to serious complications. But even when serious complications arise, it is exceedingly rare that they are life-threatening, and Gastroenterologists are well-trained to treat any complications with proven methods.The overall incidence of complications directly related to colonoscopy was 2.01 per 1000 exams ( 1.46 to 2.71).The risk of complications increased with pre-procedure warfarin use and performance of polypectomy with cautery. Perforation and bleeding are two of the major complications associated with colonoscopy.

(1)Perforation is a tear through the wall of the bowel that may allow leakage of intestinal fluids.Two of the four perforations occurred without biopsy or polypectomy. The perforation rate in diagnostic colonoscopy ranges from 0.03 to 0.8%, and in therapeutic colonoscopy it ranges from 0.15 to 3.0 %. In the majority of cases, the perforation after a colonoscopy is intraperitoneal, and only a few cases reporting extraperitoneal perforation exist in the literature.
You should contact your doctor if you feel severe abdominal pain, dizziness, fever, chills or rectal bleeding after the colonoscopy.
(2) Bleeding:
Bleeding is one of the most common complications of colonoscopy, accounting for 0.3- to 6.1% of cases. Continued bleeding after biopsy (tissue sample) or polyp removal is one of the potential problems from Colonoscopy.

(3) Nausea, vomiting, bloating or rectal irritation caused by the procedure or by the preparatory bowel cleansing.

(4)Large bowel obstruction is a rare complication after colonoscopy. The diagnosis should be considered in case of post-colonoscopy abdominal pain, because ignoring the pain and the progression of distention may lead to intestinal perforation or even air emboli.

(5) Bacterial infections: Bacteria in the blood could lead to sepsis, but this doesn't always happen. Therefore, the rate of sepsis would be even lower than that of people with bacteria in their blood.
Looking at the advantages of Colonoscopy,the risk is very negligible.The risk is equal to striking thunderbolt on you.So don't be afraid of this procedure.

Information compiled by: Dr. Bhairavsinh Raol