44391 Colonoscopy through stoma; with control of bleeding, any method

Name of the Procedure:

Colonoscopy through stoma; with control of bleeding, any method
Common name(s): Colostomy colonoscopy, Stoma colonoscopy with hemostasis

Summary

A colonoscopy through a stoma is a medical procedure used to examine the colon via an existing colostomy stoma. If bleeding is detected, the doctor will control it using various methods such as cauterization or clipping.

Purpose

This procedure addresses issues of gastrointestinal bleeding in patients with a colostomy. Its goal is to identify the source of bleeding and effectively control it to prevent further complications.

Indications

• Visible rectal bleeding from the stoma
• Unexplained anemia in a patient with a colostomy
• Surveillance post colorectal surgery
• Follow-up on previously identified lesions

Preparation

• Fasting for 6-8 hours prior to the procedure
• Adjustments to medication, especially anticoagulants and antiplatelet drugs, as instructed by the healthcare provider
• Bowel preparation involving the use of laxatives or enemas if advised by the doctor
• Pre-procedure diagnostic tests like blood tests or imaging studies

Procedure Description

1. Pre-procedure: Patient checks in and changes into a hospital gown. An intravenous (IV) line may be placed for sedation.
2. Anesthesia: Usually, conscious sedation is used, where the patient is relaxed but awake, though general anesthesia may be employed in certain cases.
3. Colonoscopy:
   • The colonoscope, a flexible tube with a camera and light, is gently inserted through the stoma.
   • The doctor advances the scope to visualize the colon, searching for the source of bleeding.
4. Control of Bleeding: If bleeding is detected, methods such as cauterization, clipping, or injection therapy are used to control the bleeding.
5. Concluding the Procedure: The scope is carefully withdrawn, and the patient is monitored as the sedation wears off.

Duration

The procedure typically takes 30 minutes to an hour, depending on the complexity and findings.

Setting

This procedure is usually performed in a hospital endoscopy unit or a specialized outpatient clinic.

Personnel

• Gastroenterologist or colorectal surgeon
• Nursing staff for procedural support and patient monitoring
• Anesthesiologist or nurse anesthetist if sedation or anesthesia is used

Risks and Complications

• Common risks: Discomfort, bloating, cramping, slight bleeding at the biopsy site
• Rare risks: Perforation of the colon, severe bleeding, adverse reactions to sedation, infection
• Managing complications: Immediate medical intervention, hospitalization, additional procedures if necessary

Benefits

• Identification and control of GI bleeding, potentially preventing serious complications
• Improved symptoms and reduced risk of anemia
• Accurate diagnosis leading to appropriate follow-up treatment

Recovery

• Post-procedure observation for about an hour to monitor for any immediate complications
• Instructions for resuming normal diet and activities (usually within 24 hours)
• Possible temporary dietary restrictions
• Follow-up appointments to discuss findings and additional treatment if necessary

Alternatives

• Non-invasive imaging studies like CT colonography, though less accurate
• Medical management with medications to control symptoms, though they may not stop the bleeding
• Surgical intervention in severe cases where endoscopic control is not feasible

Patient Experience

During the procedure, patients may feel pressure or mild cramping but should not experience significant pain due to sedation. Post-procedure, patients might feel drowsy from sedation and experience mild bloating or gas. Pain management and comfort measures include the use of mild analgesics and resting until sedation effects wear off.