Colonoscopy is a test to diagnose diseases of the large intestine - colon or the rectum. This test is done by a Gastroenterologist who is specially trained in doing Upper GI Endoscopy and Colonoscopy. The test is done by using a special equipment called `Endoscope' costing anywhere between Rs. 15 Lacs - 50 Lacs. This machine has a thin long flexible tube which contains a high definition miniature video camera, LED Light and Biopsy equipments. The diameter of the tube is around 1 - 1.25 cm.

In colonoscopy study, this thin tube is inserted through the anus and slowly pushed to cover the entire length of the large intestine. The entire procedure takes 30-60 minutes. The doctor pushes some air or carbondioxide through the tube to inflate the colon. The powerful LED Light illuminates the inside of the rectum and the video camera sends live images on the computer monitor. The Gastroenterologist examines the walls of the colon and picks up tissue samples if any polyps are seen on the walls of the colon. Polyps are tissue growths from the walls of the organ and can be cancerous. These tissue samples are then sent to the laboratory for examination under microscope to find the nature of the growth.

Colonoscopy covers the entire large intestine and the distal end of the small intestine. Different scopes are used for upper GI endoscopy and colonoscopy. After each test, the scope is thoroughly sterlized in order to disinfect and prevent cross infection.

An alternative to Colonoscopy is CT Scan Virtual Colonoscopy in which the patient lies on the CT Scan table and no tube is inserted into the rectum. 3D images of the intestine are taken and virtual walkthrough is created.

Preparing for Colonoscopy

The objective of Colonoscopy is to study the walls of the colon or the large intestine. Even when you pass stool in the morning, the rectum is never completely clean. Fecal matter remains stuck to the walls of the colon. For doing this study, patient preparation has to be very good otherwise the study would be inconclusive. The patient is advised not to eat any solid food on the day before the study. Clear liquids are to be consumed. Tea or Coffee without milk can be taken. Laxative medicine is prescribed to be taken on the previous night and also in the morning of the test. The patient will pass stool several times in order to clean the colon completely.

A sedative is given just before the test so that any kind of pain or discomfort can be avoided. The patient lies on the table on the side with knees folded towards the stomach exposing the anus. The gastroenterologist will slowly push the thin flexible tube into the rectum until the top end of the tube reaches the other end of the large intestine. The entire length of the large intestine is approximately 3 feet. Air or carbondioxide might be used to inflate the colon to get clear pictures. The doctor will slowly withdraw the tube and get live video images of the walls of the colon. The patient might feel some kind of cramping in the abdomen and may also experience bowel movement. Patients who have been taking blood thinners might have to stop these for 48 hours before the procedure as biopsy might have to be taken and blood thinners can cause heavy bleeding inside the colon.

You would be required to remain at the hospital for 2-3 hours after the study is completed before you can go home. You would need to take rest for the remaining day and can resume normal activities from the next day.

Test Results

If your doctor removed a polyp during colonoscopy you may be advised to eat a special diet temporarily. You may feel bloated or pass gas for a few hours after the exam, as you clear the air from the colon. Walking may help relieve any discomfort.

You may also notice a small amount of blood with your first bowel movement after the exam. Usually this isn't cause for alarm. Consult your doctor if you continue to pass blood or blood clots or if you have persistent abdominal pain or fever for more than 2-3 days afte the exam.

The test is considered normal if the doctor does not find any polyps in the colonic walls or any other sign of a disease in the colon. The test is considered positive if polyps are found on the walls of the colon. Most polyps aren't cancerous, but some can be pre-cancerous and can lead to colon cancer. Polyps removed during colonoscopy are sent to a laboratory for analysis to determine whether they are cancerous, pre-cancerous or non-cancerous.

If the polyps are found to be non-cancerous then nothing needs to be done. However if the polyps are found to be pre-cancerous or cancerous then further tests need to be done to find the nature and the stage of the cancer.

The results of these tests would determine the line of treatment. The treatment for colon cancer could be chemotherapy, radiotherapy or surgery. The surgery for colon cancer is to remove the part of the colon which is affected by cancer and to recreate the colon. In severe cases where the entire colon is to be removed, a colostomy bag is attached to the stomach for cleaning out the stool from the body.

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