44388 Colonoscopy through stoma; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)

Name of the Procedure:

Colonoscopy Through Stoma; Diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)

Summary

A colonoscopy through a stoma is a diagnostic medical procedure where a flexible tube with a camera (colonoscope) is inserted through a surgically created opening (stoma) in the abdomen to examine the colon. During this procedure, tissue samples may be collected using brushing or washing techniques.

Purpose

This procedure is done to diagnose or monitor conditions affecting the colon, such as inflammation, polyps, or cancer, especially in patients with a stoma. The goals are to identify abnormalities, take tissue samples for biopsy, and help guide treatment plans.

Indications

• Persistent abdominal pain
• Chronic diarrhea or constipation
• Unexplained weight loss
• Blood in stool
• Patients with a history of colon cancer or polyps
• Monitoring known colon conditions in patients with a stoma

Preparation

• Fasting: No eating or drinking for a specified period, typically starting the night before the procedure.
• Medication adjustments: Stopping certain medications like blood thinners as advised by the doctor.
• Bowel preparation: Using laxatives to clean out the colon if necessary.
• Pre-procedure assessment: Blood tests and medical history review.

Procedure Description

1. The patient is positioned comfortably, usually lying on their side.
2. Sedation or local anesthesia may be administered to ensure comfort.
3. A colonoscope is gently inserted through the stoma.
4. The colonoscope transmits video images to a monitor, allowing the doctor to examine the colon.
5. If abnormalities are observed, samples are collected using brushing or washing methods for further analysis.
6. The colonoscope is then carefully withdrawn.

Duration

The procedure typically takes about 30 to 60 minutes.

Setting

This procedure is usually performed in a hospital or an outpatient surgical center equipped with endoscopy facilities.

Personnel

• Gastroenterologist or colorectal surgeon
• Endoscopy nurses
• Anesthesiologist or sedation nurse (if sedation is used)

Risks and Complications

• Common risks: Discomfort, cramping, minor bleeding at the biopsy site.
• Rare risks: Infection, perforation of the colon, adverse reaction to sedation.

Benefits

• Early detection of colon abnormalities
• Accurate diagnosis through tissue biopsy
• Tailored treatment plans based on findings
• Peace of mind through regular monitoring

Recovery

• Post-procedure observation until the effects of sedation wear off.
• Mild discomfort or bloating may occur but usually resolves quickly.
• Normal activities can usually be resumed the next day; however, avoid heavy lifting and strenuous activities.
• Follow-up appointments if biopsy results indicate further treatment is necessary.

Alternatives

• Sigmoidoscopy: Examines only the lower part of the colon.
• Virtual colonoscopy: A non-invasive imaging test using CT scans.
• Stool tests: Non-invasive, but less accurate for detecting some conditions.
• Pros and cons vary: Less invasive options offer comfort but may lack diagnostic accuracy compared to colonoscopy through a stoma.

Patient Experience

• During the procedure: With sedation, minimal to no pain is typically experienced. Without sedation, there may be some discomfort or pressure.
• After the procedure: Possible mild cramping or bloating, which usually subsides within a few hours. Pain management includes over-the-counter medications and comfort measures like a warm compress.