45391 Colonoscopy, flexible; with endoscopic ultrasound examination limited to the rectum, sigmoid, descending, transverse, or ascending colon and cecum, and adjacent structures

Name of the Procedure:

Colonoscopy, Flexible; with Endoscopic Ultrasound Examination limited to the rectum, sigmoid, descending, transverse, or ascending colon and cecum, and adjacent structures.

• Common Name(s): Colonoscopy with Endoscopic Ultrasound (EUS)

Summary

A colonoscopy with endoscopic ultrasound is a medical procedure that combines a traditional colonoscopy with the added detail of ultrasound imaging. This allows doctors to visualize the inside of the colon and surrounding structures more clearly. The procedure is used to diagnose and sometimes treat various conditions affecting the colon and rectum.

Purpose

• Medical Condition or Problem Addressed: This procedure is commonly used to evaluate symptoms such as unexplained abdominal pain, rectal bleeding, or changes in bowel habits. It can also help in the detection and staging of cancers and benign tumors in the colon.
• Goals or Expected Outcomes: The primary goals are to diagnose conditions affecting the colon and nearby structures accurately and, if necessary, perform minor treatments during the same procedure.

Indications

• Symptoms: Abdominal pain, rectal bleeding, changes in bowel habits, unexplained weight loss.
• Conditions: Suspected colorectal cancer, polyps, inflammatory bowel disease (IBD), diverticulosis, and other abnormalities of the colon.
• Patient Criteria: Typically recommended for adults who present with the above symptoms or have a family history of colorectal cancer.

Preparation

• Pre-procedure Instructions: Patients are usually required to follow a clear-liquid diet for 24 hours before the procedure and take a bowel-cleansing solution. Certain medications may need to be adjusted, especially blood thinners.
• Diagnostic Tests: Some patients may need blood tests or other diagnostic imaging tests beforehand.

Procedure Description

1. Sedation: The patient is usually given sedation or anesthesia to ensure comfort.
2. Colonoscopy: A flexible tube with a camera (colonoscope) is inserted through the rectum to examine the entire colon.
3. Endoscopic Ultrasound: An ultrasound probe attached to the colonoscope provides detailed images of the colon and adjacent structures.
4. Interventions: If necessary, tissue samples (biopsies) can be taken, or polyps can be removed.
   • Tools and Equipment: Colonoscope with attached ultrasound probe, biopsy forceps, polyp removal tools.
   • Anesthesia Details: The procedure typically involves conscious sedation or general anesthesia, depending on the patient's condition.

Duration

The procedure usually takes between 30 minutes and 1 hour.

Setting

Performed in a hospital, outpatient clinic, or specialized surgical center equipped with endoscopic facilities.

Personnel

• Healthcare Professionals Involved: Gastroenterologist or colorectal surgeon, anesthesiologist, nursing staff, and potentially an ultrasound technician.

Risks and Complications

• Common Risks: Mild discomfort, bloating, and cramping post-procedure.
• Rare Risks: Perforation of the colon, bleeding, infection, adverse reactions to sedation.
• Management of Complications: Immediate medical intervention, possible hospitalization for severe complications.

Benefits

• Expected Benefits: Accurate diagnosis and staging of colorectal conditions, potential immediate treatment (e.g., polyp removal).
• Realization of Benefits: Improved patient outcomes through early detection and treatment, often realized immediately to within a few days.

Recovery

• Post-procedure Care: Patients are monitored until sedation wears off, typically able to go home the same day.
• Recovery Time: Most patients recover within 24-48 hours. Avoid heavy lifting and strenuous activities for a short period.
• Follow-up Appointments: Usually scheduled to discuss findings and any further treatment if necessary.

Alternatives

• Other Treatment Options: Virtual colonoscopy, CT colonography, traditional colonoscopy without ultrasound.
• Pros and Cons: Virtual colonoscopy is less invasive but may not be as detailed; CT colonography involves radiation exposure. Traditional colonoscopy without ultrasound may miss deeper tissue issues.

Patient Experience

• During the Procedure: Patients may feel some pressure or cramping but are generally sedated.
• After the Procedure: Minor discomfort such as bloating or gas, managed with over-the-counter pain relief and rest. Most patients can resume normal activities within a couple of days.