Name of the Procedure:

Colonoscopy, flexible; with directed submucosal injection(s), any substance
Common Names: Colonoscopy, Submucosal Injection Colonoscopy

Summary

A flexible colonoscopy with directed submucosal injection involves using a flexible tube with a camera to inspect the colon and rectum. During this procedure, a doctor can inject substances directly into the submucosal layer of the colon wall for therapeutic or diagnostic purposes.

Purpose

This procedure is used to diagnose and treat conditions affecting the colon and rectum. It helps in the identification of abnormalities such as polyps, inflammation, or cancer. The injections can deliver medications, staining agents, or other substances to manage these conditions or to highlight areas of concern for better visualization.

Indications

• Persistent gastrointestinal symptoms (e.g., blood in stool, unexplained abdominal pain, chronic diarrhea).
• Follow-up on abnormal results from other diagnostic tests.
• Treatment of certain conditions such as bleeding lesions or polyps.
• Surveillance for patients with a history of colorectal cancer or polyps.

Preparation

• Patients typically need to follow a clear liquid diet for 24-48 hours before the procedure.
• Bowel preparation is required, which usually involves taking a laxative solution to cleanse the colon.
• Patients may need to adjust or pause certain medications, particularly blood thinners, under the guidance of their doctor.
• Pre-procedure assessments include a detailed medical history and possibly blood tests.

Procedure Description

1. The patient is positioned on their side.
2. Sedation or anesthesia is administered for comfort.
3. A flexible colonoscope is inserted through the rectum and advanced through the colon.
4. The physician inspects the colon and may take biopsies if abnormal areas are observed.
5. Specific substances are injected into the submucosal layer if needed for treatment or diagnostic purposes.
6. The colonoscope is carefully withdrawn, and the findings are documented.

Tools and Equipment: Flexible colonoscope, injection needles, sedation equipment.

Anesthesia or Sedation: Moderate sedation or anesthesia is typically used to increase patient comfort.

Duration

The procedure usually takes about 30-60 minutes, depending on complexity.

Setting

Performed in a hospital’s outpatient department, a specialized endoscopy suite, or an ambulatory surgical center.

Personnel

• Gastroenterologist or colorectal surgeon
• Endoscopy nurse
• Anesthesiologist or sedation nurse

Risks and Complications

• Common risks: Abdominal discomfort, bloating, and mild cramping.
• Rare risks: Perforation of the colon, bleeding, reaction to sedation, infection.
• Potential complications are managed with prompt medical intervention.

Benefits

• Accurate diagnosis of colorectal conditions.
• Potential treatment of issues such as bleeding or polyps during the same procedure.
• Enhanced visualization with submucosal injections for better diagnosis.

Recovery

• Patients are monitored until sedation wears off.
• Rest is recommended for the remainder of the day.
• Normal activities can typically be resumed the next day.
• Specific post-procedure instructions (e.g., dietary guidelines) will be provided.
• Follow-up appointments may be scheduled to discuss results or additional treatment.

Alternatives

• Non-invasive tests like fecal occult blood testing or stool DNA tests.
• Imaging studies such as a CT colonography.
• Sigmoidoscopy (flexible, but examines only part of the colon).
• Each alternative has different accuracy rates, comfort levels, and may not offer immediate therapeutic options.

Patient Experience

During the procedure, patients usually experience minimal discomfort due to sedation. Post-procedure, there might be mild bloating or cramping which generally resolves quickly. Pain management and comfort measures like warm packs or mild pain relief medications may be offered if needed.