45390 Colonoscopy, flexible; with endoscopic mucosal resection

Name of the Procedure:

Colonoscopy, flexible; with endoscopic mucosal resection (EMR)

Summary

A flexible colonoscopy with endoscopic mucosal resection (EMR) is a procedure where a doctor uses a flexible tube with a camera to view and remove abnormal tissue from the lining of the colon. This is done to identify and treat polyps, precancerous growths, or early-stage cancers.

Purpose

This procedure addresses the need to detect and remove abnormal tissue from the colon to prevent or treat colorectal cancer. The goal is to visually inspect the colon and safely resect unwanted tissue without the need for more invasive surgery.

Indications

• Presence of polyps or abnormal growths detected via screening tests or imaging studies.
• Symptoms such as rectal bleeding, unexplained abdominal pain, or changes in bowel habits.
• Risk factors like a family history of colorectal cancer or previous findings of polyps.

Preparation

• Patients are usually required to follow a clear liquid diet for 24-48 hours before the procedure.
• Laxatives or bowel cleansing solutions may be prescribed to ensure the colon is empty.
• Patients may need to stop certain medications such as blood thinners or iron supplements temporarily.

Procedure Description

1. The patient lies on their side on an examination table.
2. Sedation or anesthesia is administered to ensure comfort.
3. A flexible colonoscope is inserted through the rectum and guided through the colon.
4. The doctor visually examines the lining of the colon using the camera.
5. If abnormal tissue is found, endoscopic tools are used to lift and resect (cut out) the mucosal layer containing the abnormality.
6. Removed tissue is sent to a laboratory for analysis.

Duration

The procedure typically takes about 30 to 60 minutes.

Setting

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

Personnel

• Gastroenterologist or surgeon specializing in endoscopic procedures
• Nurses or medical assistants
• Anesthesiologist or nurse anesthetist (if sedation is used)

Risks and Complications

• Common risks include minor bleeding and abdominal discomfort.
• Rare risks include perforation of the colon, significant bleeding requiring intervention, and adverse reactions to sedation.
• Complications may require hospitalization and further treatment.

Benefits

• Early detection and removal of precancerous lesions.
• Potential to prevent the development of colorectal cancer.
• Minimally invasive with shorter recovery times compared to traditional surgery.

Recovery

• Patients are usually monitored for a short period after the procedure until the sedation wears off.
• Mild discomfort or bloating is common but should subside within a few hours.
• Patients may need someone to drive them home due to the effects of the sedative.
• Normal activities can usually be resumed the next day, but strenuous activity should be avoided for a few days.
• Follow-up appointments might be necessary to discuss biopsy results or additional treatment.

Alternatives

• CT colonography (virtual colonoscopy): Less invasive but not as accurate for detecting small polyps.
• Traditional surgical removal: More invasive with longer recovery times but might be necessary for larger or more complex lesions.
• Surveillance without resection: Using imaging studies and regular follow-up without immediate removal, which might miss early intervention opportunities.

Patient Experience

Patients might feel a mild pressure or fullness during the procedure. Post-procedure, there could be bloating or cramping, which typically resolves quickly. Pain management is typically not an issue due to the sedative used. Advanced comfort measures and acareful monitoring ensure minimal discomfort during and after the procedure.