Indications of colonoscopy

Colonoscopy and most passing a flexible tube or fiberoptic scope which has a light and a camera source through the rectum into the large intestine called colon. There are several reasons why we do a colonoscopy.

One of the most common indications is to screen for colon cancer. This is currently being recommended in all adults above the age of 45. This is also indicated in adults below this age if they have a strong family history of colon cancer in a first-degree relative below the age of 60 at which time the need to start the first colonoscopy at the age of 40. During screening colonoscopy, the colonoscopist is looking for tumors in the lining of the colon called polyps. These can be of varying shapes and size. There are 2 broad categories of polyps. One are called adenomas which at the precancerous variety and these polyps can become cancer if left unchecked and allowed to grow over time. The other polyps are called hyperplastic polyps and for the most part unless there are multiple large hyperplastic polyps in the right side of the colon, usually there is a very low chance of malignancy. All polyps are routinely taken out and sent for biopsy examination to an expert pathologist. After review of the biopsy reports, the gastroenterologist decides when the patient would be eligible for a repeat surveillance examination which is usually performed anywhere from 3 to 10 years after the initial examination taking into account a variety of factors such as patient’s family history of colon cancer as well as the number, size and pathology results of the polyps.

Besides screening for colon cancer, colonoscopy is frequently performed to diagnose the cause of patient complaints at which time is called a diagnostic colonoscopy. This is use to investigate complaints of change in bowel habits, chronic diarrhea, chronic unexplained abdominal pain, rectal bleeding or anemia. It is frequently used to diagnose inflammatory bowel diseases such as ulcerative colitis and/or Crohn’s disease. When there is a strong indication to undergo this procedure, in the vast majority of patients the benefits of the procedure outweigh the small risks of exacerbating bleeding, perforation. Nevertheless, this is a constant discission making endeavor on the part of the gastroenterologist to do what is in the best interest of the patient taking into account the patient’s age, comorbidities. For instance, after the age of 85 we think that the risks of a screening colonoscopy in Redding outweigh the benefits of prevention of colon cancer and therefore after this age, no more screening colonoscopies are generally performed.

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