44394 Colonoscopy through stoma; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique

Name of the Procedure:

Colonoscopy through stoma; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique

• Common Name: Colonoscopy through stoma with snare polypectomy
• Medical Term: Stomal colonoscopic polypectomy

Summary

This procedure involves using a colonoscope, a long, flexible tube with a camera, to examine the colon through a stoma (a surgical opening on the abdomen). During this procedure, any tumors, polyps, or other lesions found are removed using a snare, a wire loop instrument.

Purpose

Indication:

• To find and remove abnormal growths like polyps and tumors in the colon that can potentially be cancerous. Goals and Outcomes:
• Removal of polyps and tumors to prevent or diagnose colorectal cancer.
• Relief of symptoms such as bleeding or obstruction caused by these lesions.

Indications

• Presence of polyps or tumors found during initial examinations or imaging studies.
• Symptoms such as rectal bleeding, changes in bowel habits, abdominal pain.
• Follow-up for patients with a history of polyps or colorectal cancer.

Preparation

• Fasting is typically required for 8-12 hours before the procedure.
• Bowel preparation involves taking laxatives or enemas to clear the colon.
• Adjustments or temporary discontinuation of certain medications may be necessary.
• Pre-procedure assessments like blood tests or imaging studies may be performed.

Procedure Description

1. Initial Setup: The patient is positioned comfortably, usually on their back or side.
2. Sedation: Mild sedation or anesthesia is administered to ensure comfort.
3. Insertion: The colonoscope is gently inserted through the stoma.
4. Examination: The colonoscope is navigated through the colon to inspect for abnormalities.
5. Snare Removal: If lesions like polyps or tumors are found, a snare is deployed through the colonoscope to encircle and remove the lesions.
6. Completion: The colonoscope is carefully withdrawn, and the removed tissue is sent for histological analysis.

Duration

Typically, the procedure takes about 30 minutes to 1 hour, depending on the complexity and the number of lesions removed.

Setting

The procedure is usually performed in an outpatient setting such as a hospital, outpatient surgical center, or specialized endoscopy clinic.

Personnel

• Gastroenterologist or Surgeon
• Nurses or Endoscopy Technicians
• Anesthesiologist (if general anesthesia or deep sedation is used)

Risks and Complications

• Common Risks: Abdominal discomfort, bloating, minor bleeding.
• Rare Complications: Perforation of the colon, significant bleeding requiring intervention, adverse reactions to sedation or anesthesia.
• Management: Prompt medical care and sometimes surgical intervention are required in case of severe complications.

Benefits

• Early detection and removal of potentially cancerous lesions.
• Symptom relief from bleeding or obstructive lesions.
• Minimized risk of colorectal cancer with early intervention.

Recovery

• Post-procedure monitoring for 1-2 hours, especially if sedation was used.
• Patients may experience mild cramping or bloating, which usually resolves quickly.
• Instructions include: avoiding certain foods, resting, and watching for signs of complications like fever or severe pain.
• A follow-up appointment is typically scheduled to discuss pathology results and any further treatment.

Alternatives

• Non-Invasive: Surveillance with regular imaging or stool tests (less definitive but lower risk).
• Surgical: Traditional surgery for lesion removal, which is more invasive and has a longer recovery time.

Patient Experience

• During: Little to no discomfort due to sedation.
• After: Potential mild cramping or bloating; normal activities can usually resume within a day.
• Pain Management: Minor discomfort is managed with over-the-counter pain medications; more intensive pain is uncommon.

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