Name of the Procedure:

Colorectal Cancer Screening: Colonoscopy for Individuals Not Meeting High-Risk Criteria Common Names: Routine Colonoscopy, Screening Colonoscopy
Technical/Medical Term: Colorectal Cancer Screening Colonoscopy (G0121)

Summary

A colonoscopy is a diagnostic procedure in which a doctor uses a colonoscope—a long, flexible tube with a camera and light at the end—to examine the interior of the colon and rectum. This allows for the detection of abnormalities such as polyps, inflammation, or cancer.

Purpose

This procedure is primarily used to screen for colorectal cancer in individuals who are not considered high-risk. The goals are to detect any abnormalities early, remove polyps which could be precancerous, and identify colorectal cancer at an early, more treatable stage.

Indications

Colonoscopy is recommended for routine screening in individuals aged 45 and older who do not have a family history of colorectal cancer, inflammatory bowel disease, or other specific risk factors. It is indicated for individuals who have not shown symptoms like blood in the stool, unexplained weight loss, or persistent abdominal pain.

Preparation

Prior to the procedure, patients must undergo bowel preparation to clear the colon. This typically involves:

• A clear liquid diet for 24-48 hours before the procedure.
• Taking a prescribed laxative solution.
• Adjusting medications, as advised by the physician, particularly those that affect blood clotting.

Procedure Description

1. The patient arrives and changes into a hospital gown.
2. An IV line may be placed for sedation or anesthesia.
3. The patient lies on their side on an examination table.
4. Sedation is administered to help the patient relax and minimize discomfort.
5. The colonoscope is gently inserted into the rectum and guided through the colon.
6. Air is sometimes pumped into the colon to expand it, providing a better view.
7. The doctor examines the colon and may remove polyps or take biopsies if any abnormal tissues are found.
8. The colonoscope is gradually withdrawn, concluding the examination.

Duration

The procedure typically takes around 30-60 minutes.

Setting

Colonoscopy is usually performed in an outpatient clinic, a hospital endoscopy unit, or a specialized surgical center.

Personnel

The procedure is conducted by a gastroenterologist or a surgeon specializing in endoscopic procedures. Supporting healthcare professionals include nurses, anesthesiologists, and medical assistants.

Risks and Complications

Common risks include mild cramping, bloating, and minor bleeding, especially if a biopsy or polyp removal is performed. Rare complications can include perforation of the colon, severe bleeding, or adverse reactions to sedation.

Benefits

Early detection of colorectal cancer greatly improves treatment outcomes. By identifying and removing polyps, the procedure can help prevent potential cancer development. The benefits are often realized within a few weeks once biopsy results are available.

Recovery

Post-procedure, patients are monitored until the effects of sedation wear off, usually an hour or two. Full recovery from sedation takes 24 hours, during which patients should avoid driving or making important decisions. Mild discomfort like gas or bloating is expected but typically resolves within a day. A follow-up appointment may be scheduled to discuss results.

Alternatives

Other screening options include:

• Fecal immunochemical test (FIT): Non-invasive but less comprehensive.
• CT colonography: Less invasive but involves radiation and may require follow-up colonoscopy.
• Flexible sigmoidoscopy: Examines only part of the colon. Deciding on an alternative depends on individual patient factors and preferences.

Patient Experience

During the procedure, patients may feel mild discomfort or pressure but should not experience significant pain due to sedation. Afterward, patients might feel groggy or have some mild cramping and bloating, which typically subsides within a day. Pain management and comfort measures include warm compresses and over-the-counter analgesics if necessary.