}November 21, 2021
jDr.. Muhannad Al-Khatib


}November 21, 2021
jDr.. Muhannad Al-Khatib


Table of Contents

    Colonoscopy is one of the most important examinations that are performed to detect diseases and abnormal changes that affect the colon. It is used for diagnostic or therapeutic reasons, depending on the case.

    An overview of the colon 

    The colon makes up the largest part of the large intestine, with a length of about 150 cm.
    The colon absorbs water and salts from the waste before excreting it, as the colon forms a passage for stool to pass into the rectum, and then out of the body through the anus.
    The colon is divided anatomically according to its location into four sections:
    • ascending colon
    • transverse colon
    • descending colon
    • sigmoid colon

    colon sections

    What is a colonoscopy? 

    For colonoscopy, the doctor inserts a long, flexible tube with a camera underneath, through the anus, into the rectum, and into the distal parts of the colon.
    The endoscope is connected to a screen where what the camera captures is displayed on the screen, enabling the examiner to see the colon and examine it and identify pathological changes, if present.
    During the endoscopy, the patient is anesthetized so that no pain is felt.
    Endoscopy can be used for therapeutic reasons, meaning that if a mass within the colon is suspected, a biopsy can be taken through endoscopy, and healthy masses and polyps can also be removed.



    Why is a colonoscopy used? 

    The doctor advises the patient to undergo a colonoscopy for one of the following reasons:
    • Gastrointestinal symptoms such as bleeding, abdominal pain, and chronic constipation or diarrhea
    • revealing of colorectal cancer The presence of polyps in the colon
    • Suspicion of inflammatory bowel diseases such as ulcerative colitis and Crohn's disease
    • Colonoscopy is done periodically in patients who have a high risk of developing colorectal cancer such as a family history of infection or advanced age.


    Preparation before a colonoscopy

    There are some instructions that the patient must follow before performing the endoscopy in order to clean the colon from the stool that obstructs the entry of the endoscope so that the examining doctor obtains a clear view of the colon.


    Diet before the endoscopy

    Some foods such as corn, nuts and red meat should be avoided about three days before the endoscopy, and it is preferable for the patient to adhere to a low-fiber diet several days before the endoscopy, solid foods and alcohol should be abstained a day before the procedure, and four hours before the endoscopy, food should not be eaten at all.

    The most important thing is to follow your doctor's instructions regarding diet.


    drink laxatives

    Often the doctor advises the patient to take laxatives before the endoscopy. The laxatives are either in the form of pills or in the form of a drink that the patient drinks.
    It is recommended to take laxatives the night before the endoscopy or in the morning of the day when the endoscopy will be performed.

    Modify some medications

    The doctor should be consulted about the medications taken. The doctor may ask the patient to adjust some medications before the endoscopy or reduce the dose taken. For example, if the patient is taking blood-thinning drugs such as warfarin, it can be stopped temporarily before the endoscopy to reduce the risk of bleeding.
    The patient is advised to take a driver or a family member with him to the hospital or clinic where the endoscopy is performed. The reason behind this is that the patient may be sedated during the endoscopy, so another person will need to drive the car instead of him on the way back.

    During a colonoscopy

    Colonoscopy is done either in the hospital or on an outpatient basis by a doctor who is an expert in the procedure.
    During the procedure, the patient is wearing a special gown and is lying on his left side with his knees raised towards his chest (fetal position).
    The patient is anesthetized either with regional anesthesia, which means the patient remains awake without feeling any pain, or general anesthesia is used in some cases.
    The examining doctor inserts the colonoscope through the anus. The endoscope is equipped with a camera and is long enough to reach all parts of the colon. The endoscope contains a small lamp and a channel that enables the doctor to release air through which the air expands the colon and gives the doctor a clearer view.
    The doctor looks for any abnormal changes in the colon and may take a biopsy of the colon if he suspects the presence of a cancerous mass, and if a polyp is found, the doctor will remove it.
    After the examination is completed, the doctor gently pulls the endoscope out. The patient may feel cramps during the withdrawal. The cramps can be relieved by resting and taking a deep breath.
    In fact, colonoscopy takes about half an hour or less in normal cases, but if a polyp or mass is found, it may take longer.

    After colonoscopy 

    After the endoscopy, the patient remains in the hospital to recover and ensure that there are no complications related to the endoscopy.
    The recovery period depends on the type of anesthetic the patient received during the endoscopy.
    You should not drive or engage in strenuous activities for at least 24 hours after the procedure.
    Avoid alcohol and smoking for at least a day after the endoscopy.
    The patient may feel temporary cramps or abdominal cramps that go away quickly.
    The patient may not have a bowel movement for several days after the endoscopy due to complete emptying of the colon. If the doctor removed the polyp during the endoscopy, the patient may notice slight rectal bleeding for a day or two after the colonoscopy.
    The examiner determines the need to stop taking diluents or adjust medications after the endoscopy.

    Colonoscopy results

    After the endoscopy, the doctor explains to the patient what happened during the endoscopy in the event that a polyp was removed or an abnormal tissue was suspected from which a biopsy was taken.
    Endoscopy results are either:

    Endoscopy results are negative

    Meaning that no abnormal changes were detected at the level of the colon and rectum, meaning that the examination was normal and there is no need for concern or fear. The doctor advises the patient to repeat the endoscopy during:
    • 10 years in the absence of a risk factor for colon cancer
    • 5 years if there were previous polyps that were removed
    • Annually if there is a high risk factor for developing cancer, such as familial polyposis, which increases the risk of colon cancer significantly.


    Endoscopy results are positive

    The results are considered positive if polyps are detected during the endoscopy or if abnormal tissue is detected in the colon.
    In most cases, the polyps are not malignant, but there is a risk that the polyp will turn into a cancerous lesion, so the doctor will remove the polyp as soon as it is discovered.
    The doctor may ask the patient to repeat the endoscopy soon if:

    • Presence of one or more polybins
    • Large polyp larger than 1 cm
    • The polyp has a shape that is close to a cancerous lesion

    In the event that the doctor is unable to remove the polyps through laparoscopy, the patient may be referred to a surgical procedure to remove them.


    polyp removal by colonoscopy

    No results

    Meaning that the doctor was not able to examine the colon clearly because of the presence of a faecal mass that obstructs the entry of the endoscope. This occurs due to the poor preparation of the patient before the endoscopy.

    In this case, the doctor asks the patient to repeat the colonoscopy within a short period with good preparation.


    Colonoscopy risks 

    Colonoscopy is generally considered a safe procedure, as the risk of complications is fairly low.
    Of the complications related to endoscopy that may occur:
    • Bleeding following a biopsy or laparoscopic polypectomy
    • A tear in the wall of the colon or rectum
    • Anesthesia related problems
    • Sepsis if the endoscope used is contaminated
    • Some complications occur before the endoscopy, such as excessive use of laxatives, which causes irritation to the skin around the anus due to continuous defecation.


    Colonoscopy Instructions 

    It is recommended to start regular colonoscopy at the age of 45, once every ten years.
    Colonoscopy is the best way to reduce the risk of developing colorectal cancer and detect it early if it occurs. In some cases, colonoscopy should be started periodically at an earlier age, i.e. before 45, in one of the following cases:
    • Having a first-degree relative with colorectal cancer
    • Inflammatory colon diseases such as ulcerative colitis or Crohn's disease
    • Having genetic diseases that increase the risk of cancer, such as familial polyposis and Lynch syndrome


    Tests alternative to colonoscopy for cancer screening

    There are alternative tests to colonoscopy in order to prevent cancer, such as:

    sigmoid colonoscopy

    In fact, this test is somewhat similar to a colonoscopy, but with a sigmoid colonoscopy, the scope is shorter and is used to view only the rectum and sigmoid colon.

    That is, the sigmoidoscope cannot examine all sections of the colon.


    Virtual colonoscopy

    Also called computed tomography of the colon, it is a less invasive procedure than colonoscopy. This technique relies on shining several sources of x-rays that are controlled by a computer. The computer combines the images with each other and gives a three-dimensional image of the rectum and colon.


    Swallow a capsule containing a camera

    In fact, this method is used to see the small intestine rather than the large intestine, where a small pill containing a camera is swallowed and this capsule travels through the digestive system from the mouth to the colon.
    This method is often used for imaging the small intestine, because it is difficult to see the colon due to aliasing and the large size of the colon, in addition to the difficulty of cleaning the colon to obtain a clear view.

    fecal transplant

    A stool sample is taken and examined in the laboratory. The occult blood in the stool is investigated, in addition to DNA testing and the necessary immunochemical tests. More information about stool culture from Here.

    The relationship between colorectal cancer and colonoscopy

    Colorectal cancer is one of the most common cancers that affect the elderly, as it is the most common cancer of the digestive system.
     Colonoscopy is the primary screening test for colorectal cancer Studies the following:
    • Cancer mortality decreased due to periodic colonoscopy
    • Endoscopic excision of polyps reduced the risk of polyps turning into cancer
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    Frequently asked questions about colonoscopy in Turkey

    Is a colonoscopy painful?

    Colonoscopy is often not painful because the patient is sedated during the colonoscopy with either local or general anesthesia.

    What should be done before a colonoscopy?

    Before the colonoscopy, you must adhere to a diet prescribed by the doctor to empty the colon of waste, in addition to the possibility of taking laxatives the day before the endoscopy to completely empty the colon.

    When should a colonoscopy be done?

    In normal cases, colonoscopy should be done periodically once every ten years at the age of 45 in order to exclude colorectal cancer and detect it early, and colonoscopy is done in pathological cases when there are symptoms of colon problems such as chronic constipation or suspicion of infections at the colon level or to remove polyps intact.

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