45388 Colonoscopy, flexible; with ablation of tumor(s), polyp(s), or other lesion(s) (includes pre- and post-dilation and guide wire passage, when performed)

Name of the Procedure:

Colonoscopy, flexible; with ablation of tumor(s), polyp(s), or other lesion(s). Also known as therapeutic colonoscopy with tumor or polyp removal.

Summary

A flexible colonoscopy with ablation involves examining the inside of the colon using a long, flexible tube with a camera at the end. During this procedure, doctors can remove abnormal growths such as tumors or polyps.

Purpose

This procedure is used to address and remove abnormal growths in the colon, such as tumors, polyps, or lesions. The primary goal is to eliminate any potentially cancerous or precancerous growths to prevent colorectal cancer and alleviate any related symptoms.

Indications

• Presence of polyps or tumors found during routine screening or diagnostic colonoscopy.
• Symptoms like unexplained abdominal pain, rectal bleeding, or changes in bowel habits.
• History of colorectal cancer or polyps.
• Positive results from fecal occult blood tests (FOBT) or fecal immunochemical tests (FIT).

Preparation

• Patients need to follow a clear liquid diet for 24 hours before the procedure.
• Complete a bowel prep regimen, which usually involves drinking a special solution to clean out the colon.
• Adjustments to medication regimens, particularly for blood thinners, may be necessary.
• Pre-procedure assessments, such as blood tests or ECG, might be required to ensure the patient is fit for the procedure.

Procedure Description

1. Patient lies on their side on an examination table.
2. Sedation or anesthesia is administered to ensure comfort.
3. A flexible colonoscope is gently inserted into the rectum and guided through the colon.
4. The colonoscope transmits video images to a monitor for real-time examination.
5. Any identified polyps, tumors, or lesions are ablated (burned off) or removed using specialized tools passed through the colonoscope.
6. Pre- and post-dilation of the colon and guide wire passage may be performed if necessary.

Duration

The procedure typically takes around 30 to 60 minutes.

Setting

Colonoscopy procedures are usually performed in hospitals, outpatient clinics, or surgical centers equipped with the necessary technology.

Personnel

• Gastroenterologist or surgeon specialized in colonoscopy.
• Nurse(s) to assist the doctor and monitor the patient’s vital signs.
• Anesthesiologist or nurse anesthetist if deeper sedation is used.

Risks and Complications

• Common risks: abdominal discomfort, bloating, mild cramping.
• Rare risks: bleeding, perforation of the colon, infection.
• Potential complications such as adverse reactions to anesthesia or incomplete removal of lesions, which may necessitate further procedures.

Benefits

• Removal of polyps and other abnormalities to prevent colorectal cancer.
• Immediate visualization and diagnosis of colon abnormalities.
• Early intervention for abnormal growths, leading to better outcomes.
• Alleviation of symptoms related to colon abnormalities.

Recovery

• Post-procedure monitoring until sedation wears off.
• Instructions to rest and avoid heavy lifting for 24 hours.
• Possible bloating and cramping as the residual air in the colon passes.
• A follow-up appointment to discuss pathology results and further treatment plans if necessary.

Alternatives

• Non-invasive screening tests such as FOBT or FIT.
• CT colonography (virtual colonoscopy) for screening purposes, though it does not allow for immediate removal of abnormalities.
• Surgical resection for larger or inoperable lesions.

Patient Experience

• During the procedure: Patients usually don't feel discomfort due to sedation or anesthesia.
• After the procedure: Temporary discomfort, such as bloating or mild cramping, is common.
• Pain management includes over-the-counter pain relievers if necessary, although significant pain is unusual. Most patients can resume normal activities the day after the procedure.