44392 Colonoscopy through stoma; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps

Name of the Procedure:

Colonoscopy through stoma with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps

• Common Names: Stoma colonoscopy, Hot biopsy polypectomy via stoma
• Technical Terms: Thermal biopsy through ostomy, Endoscopic thermocoagulation resection via stoma

Summary

A colonoscopy through a stoma involves using a flexible tube equipped with a camera and specialized tools to examine the colon. During this procedure, any detected tumors, polyps, or other lesions are removed using hot biopsy forceps, which utilize heat to cut and cauterize the tissues.

Purpose

Addresses issues related to abnormal growths in the colon, such as tumors or polyps that might be precancerous or cancerous.

• Goals: To remove abnormal growths, prevent potential progression to cancer, and diagnose underlying conditions.

Indications

• Symptoms: Blood in stool, unexplained weight loss, changes in bowel habits, or persistent abdominal pain.
• Conditions: Detected polyps, tumors, inflammatory bowel disease, or follow-up for previous colorectal surgery.

Preparation

• Instructions: The patient may need to fast for several hours before the procedure and follow a specific bowel preparation regimen to clear the colon.
• Diagnostics: Blood tests, imaging studies (like a CT scan), and review of medical history.

Procedure Description

1. The patient is positioned comfortably.
2. Sedation or anesthesia is administered to ensure comfort.
3. A colonoscope is carefully inserted through the stoma.
4. The colonoscope transmits video images to guide the doctor.
5. Any abnormal growths identified are removed using hot biopsy forceps, which use heat to excise and cauterize the area to minimize bleeding.
6. The area is inspected to ensure complete removal and to check for any immediate complications.
7. The colonoscope is then withdrawn.

Duration

Typically takes about 30 minutes to 1 hour.

Setting

Performed in a hospital, outpatient clinic, or a specialized surgical center.

Personnel

• Gastroenterologist or colorectal surgeon: Performs the procedure.
• Nurses: Assist with patient preparation, the procedure, and post-procedure care.
• Anesthesiologist or nurse anesthetist: Administers and monitors anesthesia or sedation.

Risks and Complications

• Common: Discomfort, minor bleeding, and bloating.
• Rare: Perforation of the colon, severe bleeding, infection, and adverse reactions to sedation/anesthesia.

Benefits

• Removal of potentially malignant or problematic growths.
• Relief from symptoms associated with lesions in the colon.
• Prevention of future colorectal cancer. Expected benefits are often realized immediately or within a few days post-procedure.

Recovery

• Post-procedure: Monitoring for a few hours to ensure there are no immediate complications.
• Instructions: Specific dietary instructions, avoiding strenuous activities for a few days, and watching for signs of complications.
• Recovery time: Typically a day or two.
• Follow-up: Appointment to discuss pathology results and further treatment if necessary.

Alternatives

• Watchful waiting: Regular monitoring without immediate removal.
• Other endoscopic removal techniques: Such as cold biopsy or snare polypectomy.
• Surgery: In cases of larger or more complex lesions. Pros and cons: Alternatives might have different risk profiles, recovery times, and effectiveness, which should be discussed with the healthcare provider.

Patient Experience

• During: Mild discomfort from sedation and insertion; minimal pain due to sedation/anesthesia.
• After: Possible cramping, bloating, and minor bleeding.
• Pain management: Pain relievers may be prescribed, and comfort measures will be taken to ensure the patient’s well-being post-procedure.