Name of the Procedure:

Common Name: Colorectal Cancer Screening; Colonoscopy for High-Risk Individuals
Technical/Medical Term: High-Risk Colonoscopy (HCPCS Code: G0105)

Summary

A high-risk colonoscopy is a medical procedure that involves examining the inner lining of the colon and rectum using a flexible tube with a camera. This screening is specifically for individuals who have a higher risk of colorectal cancer due to factors such as family history, genetic predispositions, or certain medical conditions.

Purpose

The primary purpose of the high-risk colonoscopy is to detect early signs of colorectal cancer and remove any suspicious polyps or growths before they can develop into cancer. The goal is early detection and prevention of colorectal cancer in high-risk individuals.

Indications

• Personal or family history of colorectal cancer or polyps
• Genetic syndromes (e.g., Lynch syndrome, Familial Adenomatous Polyposis)
• Inflammatory bowel diseases (e.g., Crohn's disease, ulcerative colitis)
• Previous diagnosis of colorectal cancer
• Certain inherited syndromes or medical conditions that increase cancer risk

Preparation

• Follow a specific diet and fasting regimen 1-3 days before the procedure.
• Take prescribed bowel preparation medications to clean the colon.
• Adjust or pause certain medications as advised by the physician, especially blood thinners.
• Undergo pre-procedure assessments, such as blood tests, if required.

Procedure Description

1. Check-in: Patient arrives and checks in at the procedure facility.
2. Pre-procedure Preparation: Patient changes into a hospital gown, and an IV line is placed for sedation.
3. Sedation: Patient is given sedation or anesthesia.
4. Colonoscopy: A colonoscope (a long, flexible tube with a camera) is inserted through the rectum and advanced to the colon. The physician examines the colon lining and removes any polyps or tissue samples if needed.
5. Completion: The scope is carefully withdrawn, and the patient is monitored as the sedation wears off.

Tools and Equipment: Colonoscope, biopsy forceps, polyp removal tools
Anesthesia/Sedation: Moderate sedation or twilight anesthesia is commonly used.

Duration

The procedure typically takes about 30 to 60 minutes.

Setting

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

Personnel

• Gastroenterologist or Colorectal Surgeon performing the procedure
• Nurse(s) assisting during the procedure
• Anesthesiologist or Nurse Anesthetist managing sedation

Risks and Complications

Common risks include:

• Abdominal discomfort and bloating
• Minor bleeding, particularly if polyps are removed

Rare risks include:

• Perforation of the colon
• Severe bleeding
• Adverse reaction to sedation or anesthesia

Complications are typically managed with prompt medical attention.

Benefits

• Early detection and prevention of colorectal cancer
• Removal of precancerous polyps
• Peace of mind through routine monitoring for high-risk individuals

Benefits are usually realized immediately if polyps are removed and pathology results are normal.

Recovery

• Patient is monitored post-procedure until sedation effects wear off.
• Instructions include rest, fluid intake, and a gradual return to normal diet.
• Avoid heavy lifting or strenuous activities for 24 hours.
• Follow-up appointments to discuss biopsy results and future screenings.

Alternatives

• Stool-based tests (e.g., fecal immunochemical test, FIT)
• CT colonography (virtual colonoscopy)
• Sigmoidoscopy

Pros and Cons of Alternatives:

• Stool-based tests: less invasive but may not detect all polyps.
• CT colonography: non-invasive, but still requires bowel prep and follow-up colonoscopy if abnormalities are found.
• Sigmoidoscopy: less invasive, only examines the lower part of the colon.

Patient Experience

During the procedure, the patient is typically sedated and may feel relaxed or drowsy. Post-procedure experiences include mild bloating, gas, and minor cramping, which usually resolve within a few hours. Pain management and comfort measures, such as warm blankets and post-procedure monitoring, are provided to ensure a comfortable recovery.