Related Subjects:
|Colorectal cancer
|Colorectal polyps
|Ulcerative Colitis
|Acute Severe Colitis
|Crohn's disease
|Familial Adenomatous polyposis (FAP)
|Surgical Stomas
🔎 About
- Informed Consent 📝: Patients must understand the procedure, potential benefits, risks (e.g., perforation, bleeding), and complications. Written consent is mandatory.
- Bowel Preparation 🚽: Laxative prep (e.g., polyethylene glycol, sodium picosulfate) the day before clears the colon. Stress importance of hydration to avoid dehydration or electrolyte imbalance.
- Sedation 💉: Light IV sedation with Midazolam ± Fentanyl (for analgesia). Monitor patient closely for respiratory depression.
- Supplemental Oxygen 💨: Nasal O₂ often given, especially in elderly or those with comorbid respiratory disease, to reduce risk of hypoxia.
- Procedure 📹: Colonoscope is inserted via rectum → advanced to caecum ± terminal ileum. Allows direct mucosal visualisation, biopsy, and therapeutic interventions.
📋 Indications
- Colonic Disease 🔬: Investigation of chronic diarrhoea, constipation, or unexplained abdominal pain.
- Screening for Polyps & Cancer 🎗: From age 50 (earlier if family history, FAP, Lynch syndrome).
- Iron Deficiency Anaemia 🩸: To rule out occult lower GI bleeding.
- PR Bleeding 🚨: Evaluation of rectal bleeding or suspected lower GI source.
- Altered Bowel Habits 🔄: Persistent, unexplained changes in stool pattern.
🛠 Interventions
- Polypectomy ✂️: Snare excision or hot biopsy. Essential for colorectal cancer prevention. Send for histology.
- Biopsy 🧫: Of any suspicious or malignant-looking lesion.
- Therapeutic Control of Bleeding 💡: Argon plasma coagulation or diathermy for angiodysplasia/bleeding lesions.
⚠️ Complications
- Perforation 🕳: Rare but serious; more likely after polypectomy or in diverticulosis. Watch for peritonitis.
- Bleeding 💉: Can be immediate or delayed (days later). Risk higher after large polyp removal.
- Sedation Reactions 😴: Respiratory depression, hypotension. Continuous monitoring is essential.
🩺 Post-Procedure Care
- Recovery 👀: Monitor until sedation has worn off. Observe for abdominal pain, fever, or rectal bleeding.
- Activity Restrictions 🚗: No driving or operating machinery for 24 hours post-sedation.
- Follow-Up 📑: Provide pathology results, arrange review, and give clear discharge instructions on red-flag symptoms.
- Repeat Colonoscopy 🔄: Interval depends on findings:
- Normal colonoscopy → 10 years.
- Adenomas → 3–5 years depending on size, number, dysplasia.
💡 Clinical Notes
- Ensure complete colonic examination. A withdrawal time of ≥6–10 minutes improves adenoma detection rate (ADR).
- Alternative imaging: CT colonography if colonoscopy incomplete/contraindicated.
- Anticoagulants/antiplatelets: assess bleeding risk, liaise with haematology/guidelines before stopping therapy.
- Colonoscopy is both diagnostic & therapeutic → cornerstone of colorectal cancer screening programmes.
