44403 Colonoscopy through stoma; with endoscopic mucosal resection

Name of the Procedure:

Colonoscopy through stoma; with endoscopic mucosal resection

• Common Names: Colonoscopy through stoma with EMR

Summary

A colonoscopy through a stoma with endoscopic mucosal resection (EMR) is a procedure where a flexible tube with a camera (colonoscope) is inserted through a surgically created opening in the abdomen (stoma) to examine the colon. During the procedure, abnormal tissue, such as precancerous polyps, is removed from the colon lining.

Purpose

• To identify and remove precancerous or cancerous growths in the colon.
• To diagnose and treat conditions affecting the colon.
• Expected outcomes include prevention of colorectal cancer, relief from symptoms, and improved colon health.

Indications

• Presence of polyps or abnormal growths detected in prior screenings.
• Symptoms such as unexplained anemia, bleeding, or changes in bowel habits.
• Surveillance for patients with a history of polyps or colorectal cancer.
• Conditions like inflammatory bowel disease (IBD) that increase cancer risk.

Preparation

• Fasting for a specified period before the procedure.
• Bowel preparation with laxatives to ensure the colon is clear.
• Medication adjustments may be necessary, particularly blood thinners.
• Pre-procedure assessments include blood tests, and sometimes imaging studies.

Procedure Description

1. The patient is typically sedated or under general anesthesia.
2. A colonoscope is carefully inserted through the stoma.
3. The colon is examined for abnormalities, such as polyps.
4. If abnormal tissue is found, endoscopic mucosal resection is performed. This involves injecting a solution under the lesion to lift it and then removing it with specialized instruments.
5. The removed tissue is sent for pathological examination.

Duration

• The procedure typically takes 30 minutes to 1 hour.

Setting

• The procedure is performed in a hospital, outpatient clinic, or a specialized endoscopy center.

Personnel

• Gastroenterologist or surgeon specialized in colonoscopy.
• Nurses and medical technicians.
• Anesthesiologist or nurse anesthetist, if sedation is used.

Risks and Complications

• Common risks: bleeding, perforation of the colon, infection.
• Rare risks: adverse reaction to sedation, damage to the stoma.
• Management may include observation, medications, or surgical intervention in case of complications.

Benefits

• Early detection and removal of precancerous or cancerous lesions.
• Can prevent the progression of colorectal cancer.
• Relief from symptoms associated with polyps or abnormal growths.
• Benefits usually realized shortly after recovery.

Recovery

• Post-procedure, the patient will be monitored for a short period.
• Instructions will include rest and avoiding certain activities for a day or two.
• Follow-up care might involve diet modifications, medication regimen, and scheduling future colonoscopies.
• Recovery time is generally short, with most patients returning to normal activities within a day or two.

Alternatives

• Traditional colonoscopy through the rectum.
• Surgical resection of the colon segment (more invasive).
• Pros of this procedure include being less invasive than surgery with quicker recovery. Cons include the risks associated with sedation and potential complications.

Patient Experience

• During the procedure, patients are usually sedated and feel no pain.
• Afterward, mild discomfort or cramping may be experienced.
• Pain management may include over-the-counter pain relievers.
• Comfort measures such as heating pads and rest are recommended.

This comprehensive outline should provide a clear understanding of the colonoscopy through stoma with endoscopic mucosal resection procedure.