44404 Colonoscopy through stoma; with directed submucosal injection(s), any substance

Name of the Procedure:

Colonoscopy through stoma with directed submucosal injection(s), any substance.

Summary

A colonoscopy through a stoma involves examining the inner lining of the colon through a stoma (an opening created surgically in the abdominal wall). During the examination, substances are injected into the submucosal layer of the colon to treat or diagnose various conditions.

Purpose

This procedure helps diagnose and treat issues within the colon, such as inflammation, polyps, or abnormal growths. The goals are accurate diagnosis, enhanced visualization, and direct treatment of specific conditions.

Indications

• Persistent gastrointestinal symptoms (e.g., abdominal pain, rectal bleeding)
• Abnormal findings from other diagnostic tests (e.g., imaging studies, stool tests)
• Monitoring for polyp recurrence or colorectal cancer
• Therapeutic intervention for known issues (e.g., removing polyps or managing bleeding)
• Patients with a surgically created stoma who require colonoscopy

Preparation

• Fasting for a specific period as instructed (usually 6-8 hours before the procedure)
• Laxatives or enemas to cleanse the colon for clear visibility
• Medication adjustments: stopping blood thinners or other specific medications
• Diagnostic tests: blood tests or imaging studies may be required

Procedure Description

1. Patient prepared in a supine or position as needed.
2. Sedation or local anesthesia is administered for comfort.
3. A colonoscope, a flexible tube with a camera, is inserted through the stoma.
4. The colonoscope transmits images to a monitor, allowing for visual examination.
5. Directed submucosal injection(s) of substances (e.g., saline, medications) are administered as needed to treat or diagnose.
6. Biopsies or removal of polyps may be performed during the examination.
7. After the procedure, the colonoscope is carefully removed.

Duration

Typically, the procedure takes 30 to 60 minutes, depending on findings and interventions required.

Setting

Performed in outpatient clinics, surgical centers, or hospital endoscopy units.

Personnel

• Gastroenterologists or colorectal surgeons
• Nurses or medical assistants
• Anesthesiologists (if general anesthesia is used)

Risks and Complications

• Common: Mild cramping, discomfort, bloating
• Rare: Perforation of the colon, bleeding at biopsy or injection sites, adverse reactions to sedation or medications, infection
• Management: Most complications are managed conservatively or with specific medical interventions.

Benefits

• Accurate and direct diagnosis of colonic conditions.
• Therapeutic benefits such as the removal of polyps, control of bleeding.
• Potentially immediate feedback and resolution for certain conditions.

Recovery

• Post-procedure monitoring for short duration until sedation wears off.
• Generally able to resume normal activities within a day.
• Instructions: Hydration, specific diet recommendations, and avoiding strenuous activities.
• Follow-up appointments to discuss results and any necessary further treatments.

Alternatives

• Traditional colonoscopy (if anatomically feasible and appropriate).
• Non-invasive imaging studies (e.g., CT colonography).
• Stool tests for colorectal cancer screening.
• Pros and cons: Non-invasive tests may be less accurate; traditional colonoscopy might not be possible for patients with a stoma.

Patient Experience

During the procedure, the patient may feel minimal discomfort due to sedation. Post-procedure, there may be slight bloating or cramping which usually resolves quickly. Pain management and comfort are prioritized, and patient instructions are provided to ease recovery.