What is a colonoscopy?

A colonoscopy is a procedure performed by gastroenterologists to examine the colon (large intestine) by inserting a long, thin flexible camera called a colonoscope. The procedure is performed for many reasons including as a part of routine health maintenance (called screening test – screening or looking for colon cancer) or if there is a family history of colon cancer. He may want to investigate intestinal signs and symptoms to identify causes of abdominal pain, rectal bleeding, chronic constipation or diarrhea, or other gastrointestinal complaints.

If necessary, benign growths or lesions in the inner lining of your colon called polyps can be removed, or biopsies of abnormal tissue can be taken during this procedure.

Who Should Have a Colonoscopy?

A colonoscopy is recommended as a routine health maintenance procedure in anyone starting at the age of 50 for colon cancer prevention. In African American patients, a screening colonoscopy may be appropriate starting at age 45.

Colonoscopy can also be performed earlier than 50 years of age, if there is a family history of colon cancer. 

In 2018, the American Cancer Society decreased the age for screening colonoscopy for the average population to 45 due to an increase in the incidence of colon cancer in younger individuals based on some studies that have been published recently. However, other expert groups including the Multi-society Preventative Task force (MSPTF, the apex guidelines in the USA) have not changed their recommendations.

A colonoscopy can also performed to help diagnose problems when patients have colon specific symptoms such as a change in bowel habits, persistent diarrhea, blood in your stools, abdominal pain, unexplained weight loss or anemia (low red blood count/low hemoglobin).

What is a flexible Sigmoidoscopy?

Occasionally, a full colonoscopy may not be possible or desired nor clinically indicated. In this case, examination of the colon is limited to evaluation of the left side of the colon and this is called as a flexible sigmoidoscopy. Many of the preparations needed for the colonoscopy may also be required for flexible sigmoidoscopy.

What do I have to do to prepare for the procedure?

The success of a colonoscopy is dependent on whether the gastroenterologist can adequately visualize (see) the inner lining of the colon called the mucosa, and this is critically dependent on the bowel preparation being adequate (good enough prep to clear out the stools). Therefore, it is critical that you follow the instructions given to you.

As a rule:

7 days prior to your procedure:

1. Avoid fruits or vegetables with skin or peels on them.
2. Stop any multi-vitamins or iron supplements.
3. If you suffer from constipation or are taking any narcotic pain medications (like Tylenol 3, Norco, Percocet, Morphine, Oxycodone etc), we will usually prescribe a daily laxative (usually Miralax or a generic equivalent) to be taken daily, starting 5-7 days prior to your procedure and you may have to take an additional dose on the morning prior to your procedure.

5 days prior to your procedure:

1. If you are on blood thinners like Plavix (Clopidogrel), Brilinta (Ticagrelor) or Effient (Prasugrel), we will ask you to stop them for 5 days prior to the procedure. If you are on Coumadin (Warfarin), Eliquis (Apixaban) or Xarelto (Rivaroxoban), we will usually ask you to stop them 3-5 days prior to your scheduled procedure date.

Please note – we will give you specific instructions based on your individual circumstances or conditions and we will usually get clearance from your prescribing physician prior to stopping any of these medications. DO NOT STOP THESE MEDICATIONS WITHOUT DISCUSSING WITH US AND/OR TALKING TO YOUR PRESCRIBING PHYSICIAN.

1 day prior to your procedure:

1. You should stay only on clear liquids (any liquid that you can see through) including tea or coffee without creamer, clear juices without bits or pieces, broth and water. Drink plenty of fluids to keep you hydrated.
2. If you suffer from chronic constipation or take narcotic medications, we will ask you to take an additional dose of bowel prep or Miralax in the morning.
3. If you are diabetic, you will need to monitor your blood glucose carefully.  We will give you specific instructions, if you are on insulin or take oral hypoglycemic agents like Glyburide or any of the newer drugs. We will try and schedule your procedure(s) early in the morning on the planned date.

1. The regular/routine prep is usually split into two parts – one taken early in the evening and the other part taken between 10pm and midnight (for morning procedures) or between 3am and 5am for late morning or afternoon procedures. We will give you instructions based on the type of preparation (laxative) prescribed for you and the timing of your procedure.

What happens on the day of my procedure?

We will ask you to come an hour prior to your scheduled time to register and be admitted to our endoscopy unit (we do procedures at the hospital or at the ambulatory surgical center). The nursing staff will help you change into a comfortable gown and place you on a stretcher. An IV line will be placed to help us give you fluids and medications for the procedure. You will be asked to complete a health questionnaire, confirm your consent for the procedure and may meet a member of the anesthesia staff. Once the documentation and safety checks have been completed, you will be taken to the procedure room and asked to lie on your left side. You will then be given anesthesia or moderate sedation and go off to sleep. Once the procedure is completed, you will wake up and usually experience no pain or discomfort. Occasionally, people may complain of a sensation of bloating.

You will be taken to the recovery area and be monitored for about 30 mins prior to being discharged home.

You will need to have a driver pick you up from the unit and drive you home. Ideally, there should be someone with you at home to supervise your recovery as you may experience some drowsiness or groggy feeling as the sedative/anesthetic agent works its way out of your body.

Important:

1. We strongly urge you to not drive on the day of your procedure as your reflexes may be slower that you anticipate.

2. For safety reasons, you cannot use a taxi or public transportation to go home.

3. We strongly urge you to defer planning or making any legal decisions for up to 24 hours after the procedure, to ensure that your mind is clear and unaffected from the residual effects of anesthesia or moderate sedation.

4. We recommend not making any travel plans for up to a week after your procedure. This varies greatly – please discuss any planned or upcoming travel with Dr. Siddique at the time of scheduling.

Will any aftercare be necessary?

You may feel bloated or gassy for a few hours until any excess air is released from the colon. If any polyps are removed, you may notice a small amount of blood in the next bowel movement.

You will be told when to restart your blood thinners after your procedure.

If you notice more a lot of blood in your stools or notice severe abdominal discomfort, then please call us or go to the nearest ER for evaluation as this is unusual and should be investigated.

The results of the biopsies will be sent in the mail to you, usually, within two weeks along with any recommendations.