Name of the Procedure:

Colonoscopy, flexible; with transendoscopic ultrasound guided intramural or transmural fine needle aspiration/biopsy(s), includes endoscopic ultrasound examination limited to the rectum, sigmoid, descending, transverse, or ascending colon and cecum.

Summary

A colonoscopy with endoscopic ultrasound (EUS) is a procedure that allows a doctor to view the inside of the colon and rectum, as well as obtain images of the colon's lining using ultrasound technology. During this procedure, the doctor can also perform a fine needle aspiration or biopsy to collect tissue samples for further examination.

Purpose

This procedure is used to investigate and diagnose various conditions affecting the colon and rectum, such as tumors, polyps, and abnormalities in the colon wall. The primary goal is to examine the colon in detail, obtain tissue samples, and provide a precise diagnosis that can guide further treatment.

Indications

• Persistent abdominal pain or discomfort
• Unexplained changes in bowel habits
• Detection of blood in the stool
• Abnormal results from other imaging tests
• Monitoring of known colorectal conditions
• Screening for colorectal cancer in high-risk individuals

Preparation

• Patients may be required to follow a special diet and bowel preparation regimen, usually involving a liquid diet and laxatives, to ensure a clear view during the procedure.
• Fasting for several hours before the procedure may be necessary.
• Medication adjustments might be needed, particularly with blood thinners or medications for chronic conditions.
• Pre-procedure assessments, such as blood tests or ECG, may be required.

Procedure Description

1. The patient is given sedation or anesthesia for comfort.
2. A flexible colonoscope with an ultrasound probe attached to its tip is inserted through the rectum and advanced through the colon.
3. The colonoscope allows the doctor to visually inspect the colon's interior and use ultrasound technology to obtain detailed images of the colon walls.
4. If abnormalities are detected, fine needle aspiration or biopsy may be performed to collect tissue samples.
5. The collected samples are sent for pathological examination to diagnose conditions.

Duration

The procedure typically takes about 30 to 60 minutes, but preparation and recovery time can extend the total duration.

Setting

The procedure is usually performed in a hospital, outpatient clinic, or a specialized surgical center.

Personnel

• Gastroenterologist or colorectal surgeon
• Anesthesiologist or nurse anesthetist (if sedation or anesthesia is used)
• Trained nurses or endoscopy technicians

Risks and Complications

• Bleeding at the biopsy site
• Perforation or injury to the colon wall
• Infection
• Adverse reactions to sedation or anesthesia
• Mild abdominal cramping or bloating post-procedure

Benefits

• Accurate diagnosis of colorectal conditions
• Early detection and treatment of colorectal cancers
• Comprehensive evaluation of colon abnormalities
• Minimally invasive with a relatively quick recovery

Recovery

• Patients are monitored until the effects of sedation wear off.
• Mild discomfort or bloating may be experienced post-procedure.
• Avoid heavy lifting and strenuous activities for a short period.
• Follow-up appointments to discuss biopsy results and further treatment, if needed.

Alternatives

• Traditional colonoscopy without ultrasound
• CT colonography (virtual colonoscopy)
• Stool tests for blood or DNA markers
• Pros and cons: Less invasive options like stool tests are less comprehensive, while CT colonography does not allow for biopsy.

Patient Experience

• Most patients do not feel pain during the procedure due to sedation.
• Post-procedure, some abdominal discomfort or cramping may occur.
• Pain management includes over-the-counter pain relief if needed.
• Overall, the procedure is well-tolerated and patients can usually return to normal activities within 24 hours.