45382 Colonoscopy, flexible; with control of bleeding, any method

Name of the Procedure:

Colonoscopy, flexible; with control of bleeding, any method

Common Names:

• Colonoscopy
• Flexible Colonoscopy with Bleeding Control

Summary

A colonoscopy is a medical procedure where a doctor uses a long, flexible tube with a camera (colonoscope) to view the inside of the large intestine (colon). This specific procedure also includes methods to control any bleeding found during the examination.

Purpose

The procedure is used to diagnose and treat various conditions within the colon, such as bleeding, polyps, or abnormal growths. The goal is to visualize the colon, identify the source of bleeding, and control it through various methods like cauterization, clipping, or injection therapy.

Indications

• Unexplained gastrointestinal bleeding
• Anemia of unknown origin
• Suspected colon polyps or tumors
• Chronic diarrhea or constipation
• Inflammatory bowel diseases like Crohn's or Ulcerative Colitis
• Positive fecal occult blood test

Preparation

• Patients are typically instructed to follow a clear liquid diet for 24 hours before the procedure.
• A bowel prep (laxatives) is required to clean out the colon.
• Certain medications, especially blood thinners, may need to be adjusted or paused.
• Diagnostic tests such as blood work may be required beforehand to assess bleeding risk.

Procedure Description

1. The patient is given sedatives or anesthesia to ensure comfort.
2. The colonoscope is gently inserted through the rectum and advanced through the entire colon.
3. The camera transmits images to a monitor, allowing the doctor to examine the colon's lining.
4. If bleeding is found, the doctor uses various tools attached to the colonoscope (like a cautery device, clips, or injection needles) to stop the bleeding.
5. Tissue samples (biopsies) may also be taken for further analysis.
6. The scope is withdrawn slowly, sometimes performing additional treatments if needed.

Duration

Typically, the procedure lasts between 30 minutes to 1 hour.

Setting

A colonoscopy is generally performed in an outpatient setting, such as a hospital, surgical center, or specialized outpatient clinic.

Personnel

• Gastroenterologist or colorectal surgeon
• Nurses
• Anesthesiologist or nurse anesthetist

Risks and Complications

• Perforation of the colon
• Bleeding, especially at biopsy or treatment sites
• Adverse reactions to anesthesia
• Infection
• Post-polypectomy syndrome (abdominal pain, fever)

Benefits

• Identification and immediate control of bleeding
• Early detection and removal of polyps, which can reduce the risk of colon cancer
• Diagnosis and treatment in a single procedure
• Relief from symptoms associated with gastrointestinal issues

Recovery

• Patients are usually observed for a short period after the procedure.
• They may experience minor bloating or discomfort.
• Full recovery is typically within 24-48 hours, though sedation effects may take longer to wear off.
• Patients are advised to rest for the remainder of the day and avoid heavy lifting or strenuous activity. Follow-up appointments or additional tests might be scheduled based on findings.

Alternatives

• CT colonography (virtual colonoscopy)
• Flexible sigmoidoscopy (examining only the lower part of the colon)
• Double-balloon enteroscopy (for small intestine)
• Medical management with medications
• Pros and cons: Non-invasive alternatives like CT colonography do not allow for immediate biopsy or treatment of bleeding.

Patient Experience

Patients may feel drowsy or groggy during and after the procedure due to sedation. Some mild cramping or bloating can occur but usually resolves quickly. Pain management includes over-the-counter pain relief if necessary and following dietary recommendations to ease digestion. Comfort measures may include relaxing in a quiet room post-procedure to reduce any anxiety or discomfort.