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Colonoscopy is a procedure when a flexible tube which has a fiber-optic light source and a camera is passed through the anus into the large intestine or colon.
The most important and perhaps most difficult aspect of performing this procedure is the work done by the patient the night before to cleanse the colon. This involves drinking a half or a full gallon (2 or 4 liters) of a laxative solution as well as avoiding high residue dietary ingredients like fresh fruit, vegetables, nuts or seeds. Recent randomized controlled trials have suggested the advantage of taking the laxative solution in a split dose with a half of the volume of the laxative the night before and the other half the morning of the procedure. It cannot be over emphasized that a clean colon with no residual stool is essential to picking up any abnormalities in the colon especially flat or small polyps. Therefore cleaning the colon is most important when the procedure is being performed for screening for colon cancer.
Colonoscopy is often performed to evaluate patients presenting with symptoms referable to the large intestine such as rectal bleeding, anemia, lower abdominal pain or discomfort, recent change in bowel habits, constipation or diarrhea and unexplained weight loss.
Colonoscopy is commonly used to screen for colon cancer. Colon cancer incidence is reducing thanks to widespread adoption of screening. Since the colon can be easily visualized directly with insertion of a scope, this allows us to screen and prevent colon cancer. Colon cancer starts off as a small polyp or growth in the inner lining of the colon. During colonoscopy, we can easily detect and remove such polyps before they get a chance to grow into a full blown cancer.
The colonoscopy procedure usually takes just 15-20 minutes. It is performed with sedation, either conscious sedation where the patient is asleep but can be aroused with loud verbal or tactile stimulation. This is achieved by intravenous injection of sedative like midazolam and pain medication like meperidine or fentanyl. Alternatively monitored anesthesia care with intravenous propofol is also used for difficult to sedate patients.
Overall the risks of a colonoscopy are very low, on an average less than 0.01%. The complications are primarily bleeding(0.5%) or perforation(0.01% in a screening population)