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COLONOSCOPY

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Abstract

VOL: 99, ISSUE: 20, PAGE NO: 29

WHAT IS IT?

- Colonoscopy is an investigation that uses a flexible, fibre-optic endoscope to examine the rectum, colon and terminal ileum. It is usually performed in an outpatient clinic, under light sedation.

- Videoscopes are now used, whereby a camera-imaging tip sends pictures to a high-resolution television screen.

WHY IS IT PERFORMED?

- As a diagnostic tool for patients with symptoms such as lower gastrointestinal bleeding, change in bowel habit or abdominal pain.

- To evaluate or follow up inflammatory bowel disease.

- To screen for polyps or colorectal cancer.

- For interventions such as removal of foreign bodies, polypectomy, stricture dilatation and stenting (for example of a malignancy).

- Contraindications: acute colitis/diverticulitis, severe cardiac and chest complaints, abnormal coagulation, liver cirrhosis, pregnancy.

PATIENT PREPARATION

- Take a full medical history from the patient.

- Explain the procedure and gain informed consent.

- The bowel is cleared before the procedure and the patient should be given full instructions regarding the medication used for this purpose.

- The patient may be on free fluids only or a light diet the day before.

PERFORMING A COLONOSCOPY

- The patient is cannulated.

- Sedation and analgesia, such as intravenous midazolam and pethidine, is given in incremental doses.

- The patient is positioned in the left lateral position.

- The endoscopist performs a digital, rectal examination.

- The endoscope is lubricated and inserted into the anus.

- It is guided along the lumen of the rectum and colon using a variety of methods: torsion, withdrawal, twisting and untwisting.

- Nursing staff assist in moving the patient or applying abdominal pressure to help the endoscope move forward.

- Once the whole colon has been viewed, the endoscope is removed slowly, allowing full visualisation again on withdrawal. Biopsies may be taken during removal.

- Polyps may be identified and removed using a snare and electrocautery.

DURING THE PROCEDURE

- Monitor the patient’s level of consciousness and physiological signs (such as heart rate and oxygen saturation).

- Ensure resuscitation equipment and reversal agents are to hand.

- Observe the patient’s tolerance of the procedure, for example, pain.

- Provide reassurance, commentary and support.

- Watch out for unexpected events such as vomiting, cardiorespiratory depression and vasovagal reactions.

- Document time, dosage and route of all medications.

- Assess and document patient’s status on completing the procedure.

AFTER THE PROCEDURE

- Assess and monitor the patient until he or she has fully recovered.

- Document all care given and any unusual events that occurred.

- Provide written instructions regarding diet, medications, activity restrictions, follow-up and complications.

- Make sure the patient is accompanied home.

POTENTIAL COMPLICATIONS

- Major complications: colonic perforation, haemorrhage, over-sedation, cardiorespiratory events, septicaemia.

- Minor complications: incomplete procedure due to abdominal discomfort, rectal bleeding.

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