colonoscopy

Colonoscopy



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Colonoscopy
Diagnostic procedure, interventional US Navy 110405-N-KA543-028 Hospitalman Urian D. Thompson, left, Lt. Cmdr. Eric A. Lavery and Registered Nurse Steven Cherry review the monitor whil.jpg
A patient undergoing a colonoscopy.
Gastroenterology type
ICD-9-CM 45.23
MeSH D003113
MedlinePlus 003886
Colonoscopy (or colonoscopy) is a diagnostic test aimed at exploring the inner walls of the colon, to discover possible lesions, ulcerations, occlusions, tumor masses. It is an important tool for prevention, which allows to identify and, if necessary, remove instantly even very small and early cancers, preventing their development and degeneration. Colonoscopy is recommended as a correct screening activity for all those at risk: for example for those familiar with colon cancer; or in any case after the age of 50, when the presence of blood is detected from the stool, even in small traces.

Index
Preparation 1
2 Instrumental examination
3 Alternative methods for colon examination
4 Possible complications
5 Notes
6 Related items
7 Other projects
Preparation
A correct preparation of the patient for colonoscopy is to completely empty the colon, so as to leave the walls smooth and free of excrement, so as to allow a correct view of the interior; for this purpose:

during the four days before the exam, you should not eat fruit, vegetables or bran;
the day before the exam you must limit yourself to a light lunch, and then completely stop any solid diet;
during the day before the exam, you should drink plenty of water, ingest large amounts of laxative and perform a final cleaning enema.
Instrumental examination

Moment of excision of a small polyp during a colonoscopy. At the bottom the caliper in the direction of the polyp.
The examination is performed through the anal introduction of a probe, called a colonoscope, which has a diameter from about 11 mm to 13 mm. The probe, equipped with a micro-camera, shows in real time the inside of the colon. To facilitate the penetration of the probe, the colon itself is dilated by blowing in air, a process that can in some cases be bothersome and even painful. Depending on the section explored, we can distinguish:

Rectoscopy (only the rectum is affected by the examination).
Rectosigmoidoscopy (we also examine the sigma, the section immediately upstream of the rectum, which is often very convoluted and can be very difficult to explore, in which case particular maneuvers are put in place to try to "carry out" the convoluted trait and straighten it so as to facilitate the progression of the instrument Frequently the passage of the sigma is the most delicate and potentially annoying moment of the whole exam).
Left colonoscopy (up to the left colonic flexure, along the descending colon).
Pancolonscopia (all the colon is affected by the examination).
Pancolon-ileoscopy (if the conditions allow it, try to force the ileocecal valve to explore the distal ileus, usually for about 20 cm.) This examination is very useful when, for example, you want to check the ileum's involvement in an inflammatory process like Crohn's disease).
If the tumor masses are found they can be removed directly, then proceed to the histological section and the anatomopathological examination.
Alternative methods for colon examination
By x-rays (examination called Rex, matt enema). It is used when colonoscopy is contraindicated or impossible, but gives less precise results.
Colongrafia TAC. It is a new method that for now gives inferior results to the classic colonoscopy. The 64-detector multi-layer CT scan is a virtual endoscopy [1] that performs very high-level measurements of 160 submillimetric layers per second, and through a special software it allows to obtain high quality 3D images. It requires the same preparation of the traditional colonoscopy for the cleaning of the intestine, it is not invasive, it does not require sedation and it also allows endoscopy of moving parts. However, it is less sensitive to detect lesions of less than 10 mm or flat lesions; It also exposes the patient to a radiation dose about four times higher than a mammogram and may still require the subsequent execution of a traditional colonoscopy. [2]
The videocapsula is a totally different examination from the virtual colonoscopy both for the instrumentation used and for the indications on the cases in which it is used. It is a capsule that is ingested by the patient, transported by the movements of the intestine during its transit and then expelled with the faeces. It is used not for the study of the colon, but to examine the small intestine in cases of unexplained anemia to rule out occult bleeding at this level or in cases of suspected inflammatory bowel disease affecting the small intestine. It does not require radiation exposure.
Robotic colonoscopy represents an alternative that combines the advantages of traditional colonoscopy (diagnostic accuracy, intervention possibilities) both to a lower invasiveness and to the reduction or complete elimination of risks of infection and perforation. The colonoscope is inserted manually into the patient up to the rectum and later navigation to the cecum is autonomous and controlled by external devices, which do not require radiation exposure. The autonomous advancement of the probe excludes the operator's maneuvers to facilitate the progression of the colonoscope and minimizes the need for air blowing, therefore it is not necessary to resort to patient sedation.
Possible complications
Colonoscopy does not guarantee the visualization of all tumors
Hemorrhages following the removal of tumor masses
Possible perforation of the colon
Cardio-vascular problems especially following the use of sedatives
Although very rare, with this test there is a risk of death, with a statistic of 0.02% (2 cases per 10,000 tests carried out) and a complication rate ranging between 0.3 and 1.7%. [ 3]


Note
^ Tommaso G. Lubrano, "At the university center of Turin" Gentle surgery "for colon cancer Survival determined by primary prevention", La Stampa - Tuttoscienze, 24/01/2001 Copy filed (PDF), on ernia.org. URL consulted on March 3, 2010 (filed by the original URL on September 12, 2014).
^ (EN) Brenner DJ, Georgsson MA, Mass screening with CT colonography: Should the radiation exposure be of concern? (abstract), in Gastroenterology, vol. 1, nº 129, July 2005, pp. 328-337, PMID 16012958. URL consulted on May 17, 2011.
^ Colonoscopy