Colonoscopy

A variety of techniques are available to investigate the large bowel (colon and rectum) but the “gold-standard” remains the colonoscopy. It is the most accurate means by which pathological processes may be identified and offers advantages in that specimens may be removed to allow careful assessment and conditions (such as polyps and early cancers) effectively treated.

After taking an oral bowel preparation appropriate to the individual patient, usually at home combined with some dietary restriction, admission is made to hospital as a day case. A consent form is signed by surgeon and patient. An intravenous cannula is inserted and a sedative/ pain-killer administered. The scope is inserted through the anal canal and guided around the rectum and colon whilst the patient is lying on the left side either relaxed and resting or in a light but easily arousable sleep.

The procedure takes about 15 to 20 minutes to complete and the results can usually be given and clearly understood within an hour or so of completion. Any biopsies taken will be sent for pathological assessment and results may not be available for several days. Normal diet and activity may be resumed over the next 24 hours although a small amount of abdominal discomfort may remain over this period which usually improves with passing wind.

Complications of bowel preparation include nausea, vomiting and dehydration. Complications of the procedure include colonic bleeding (less than 1 in 100 cases) and perforation (less than 1 in 1000 cases). Both complications may require hospital admission, observation and/ or emergency surgery.

A variety of procedures may be undertaken at colonoscopy from simple biopsies to removal of large and complicated polyps or even early bowel cancers; these procedures may be time consuming but are generally painless. The techniques are highly specialised and use injection techniques and high frequency electric current to carry out complex tasks.

The Transverse Colon	The Caecum (Appendix orifice and ileocaecal valve seen)