Name of the Procedure:

• Common Name: Screening Colonoscopy
• Technical/Medical Term: Colonoscopy (HCPCS Code G2204)

Summary

A screening colonoscopy is a medical examination used to detect changes or abnormalities in the large intestine (colon) and rectum. The procedure involves the use of a flexible tube with a camera to view the interior lining of the colon.

Purpose

Screening colonoscopies are performed to:

• Detect early signs of colorectal cancer.
• Identify and remove precancerous polyps.
• Investigate symptoms such as abdominal pain, rectal bleeding, or changes in bowel habits. The primary goal is to prevent colorectal cancer by identifying and addressing issues at an early, more treatable stage.

Indications

• Adults between 50 and 85 years of age.
• Individuals with a family history of colorectal cancer or polyps.
• Patients with symptoms like unexplained anemia, persistent diarrhea, or rectal bleeding.
• Those with inflammatory bowel diseases like Crohn's disease or ulcerative colitis.

Preparation

• Patients generally need to follow a clear liquid diet for 24 hours before the procedure.
• A bowel cleansing regimen is required to empty the colon, which may involve drinking a laxative solution.
• Patients may need to adjust or temporarily discontinue certain medications, particularly blood thinners.

Procedure Description

1. The patient is given sedation or anesthesia to ensure comfort.
2. A colonoscope, a long flexible tube with a camera, is inserted through the rectum and guided through the colon.
3. The doctor examines the colon's lining, looking for abnormalities such as polyps or tumors.
4. If polyps are found, they can be removed immediately using special tools passed through the colonoscope.
5. Tissue samples (biopsies) may be taken for further analysis if needed.

Duration

The procedure typically takes about 30 to 60 minutes.

Setting

Screening colonoscopies are usually performed in a hospital, outpatient clinic, or surgical center.

Personnel

• Gastroenterologist or trained surgeon
• Anesthesiologist or nurse anesthetist
• Nurses and medical assistants

Risks and Complications

• Perforation of the colon wall (rare)
• Bleeding, especially if a biopsy or polyp removal is performed
• Adverse reactions to sedatives or anesthesia
• Infection (very rare) Complications are generally manageable, and the medical team is prepared to address them promptly.

Benefits

• Early detection of colon abnormalities can significantly reduce the risk of colorectal cancer.
• Removal of polyps before they become cancerous.
• Most patients can return to normal activities the day after the procedure.

Recovery

• Patients typically rest in a recovery area until the effects of sedation wear off, usually about 30 minutes to an hour.
• Mild bloating or cramping may occur but usually subsides within 24 hours.
• It's important to have someone else drive the patient home.

• Follow-up instructions include dietary recommendations and physical activity limitations.

  Alternatives

• Fecal immunochemical test (FIT) or fecal occult blood test (FOBT): Less invasive but may miss some polyps.
• Flexible sigmoidoscopy: Examines only the lower part of the colon.
• CTC (CT colonography): A non-invasive imaging test, but a positive result requires a traditional colonoscopy for confirmation.

Patient Experience

• Sedation ensures that patients typically do not feel pain during the procedure.
• Some mild discomfort, cramping, or bloating may be felt afterward.
• Clear communication with the medical team about any anxiety or concerns can help improve comfort levels. Pain management and relaxation techniques, such as deep breathing exercises, can enhance the experience.