Preparing for the test – Colonoscopy

Colonoscopy is an endoscopic examination that allows a detailed inspection of the entire large bowel, the collection of diagnostic samples or a polypectomy (removal of polyps, most of which develop into tumours).

Colonoscopy is by far the most sensitive test – statistics show that it can detect approximately 95 % of cancers. Colonoscopy with polypectomy, performed regularly, is probably the most effective method of combating bowel cancer. Estimates suggest that it reduces the risk of developing the disease by 76–90 % and reduces mortality by 69 %.

 

WHAT IS A COLONOSCOPY FOR?

We perform colonoscopy for diagnostic, therapeutic and preventive purposes. Diagnostic colonoscopy is used to identify diseases of the large bowel, both inflammatory and neoplastic. Almost all tumours, including all cancers, originate in the layer of the bowel wall that lines its inner surface, known as the mucosa. Colonoscopy allows us to confirm or rule out the presence of a tumour and identify the cause of many symptoms, including diarrhoea, constipation, abdominal pain, a feeling of incomplete bowel emptying, narrow or pencil-thin stools, mucus in the stool and others. A screening colonoscopy should be performed at the age of 50. If no abnormalities are found, the next test is performed after 10 years. People whose immediate family includes someone diagnosed with a polyp or cancer before the age of 60 should have their first colonoscopy at the age of 40. Individual indications are, of course, determined by the referring doctor. If abnormalities are found, the doctor will recommend further management after the test, depending on their nature, and advise when a follow-up colonoscopy should take place.

Colonoscopy allows the inside of the entire large bowel, and even the final section of the small bowel, to be assessed. The adult large bowel is on average 120 cm long and consists of a very short, 3-4 cm anal canal, a 12 – 20 cm rectum and a colon approximately 1 metre long. The test is performed using a colonoscope, a thin, long and flexible endoscope inserted through the anus. The endoscope contains an optical fibre that illuminates the section of bowel being examined. Next to the optical fibre is a camera lens, which allows the person performing the test to view the inside of the bowel on a monitor, while the patient and other doctors can also follow the images.

 

INDICATIONS FOR COLONOSCOPY

If you have recently experienced symptoms such as:

• troublesome constipation,
• a change in bowel habits that cannot be explained by a change in diet or lifestyle,
• diarrhoea accompanied by passing large amounts of wind, lasting for many weeks,
• anaemia (most commonly experienced as reduced physical capacity, increased susceptibility to fatigue and a raised temperature),
• pain in the lower abdomen and lower back, discomfort, nausea, vomiting,
• a feeling of incomplete bowel emptying,
• traces of blood on toilet paper or underwear, rectal bleeding,

this is a sign that it is high time to book a colonoscopy.

Regardless of the indications above, colonoscopy to screen for bowel cancer should be performed every 10 years in people aged 50 and over who are at average risk. In people who have had a polypectomy, follow-up colonoscopy should be repeated every 2-3 years, or every year if there were multiple polyps (more than 5)

CONTRAINDICATIONS

Colonoscopy is an invasive test, meaning that it involves breaching tissue integrity and carrying out certain procedures inside the body. There is therefore always a possibility of complications, although their frequency is minimised by increasingly advanced equipment and the growing expertise of the doctors performing the test. Contraindications to colonoscopy include a flare-up of inflammatory bowel disease affecting the large bowel (ulcerative colitis or Crohn’s disease), signs of peritonitis, suspected perforation (rupture) of the digestive tract, severe heart and lung disease (for example, a heart attack or decompensated heart failure), acute respiratory failure, pregnancy and blood clotting disorders (if a biopsy or polyp removal is planned). In people who have recently undergone abdominal and/or pelvic surgery, colonoscopy is not normally performed soon after the operation unless there are absolute indications for it. Performing the test shortly after surgery may involve greater discomfort for the patient and a higher risk of complications. Decisions about postponing colonoscopy until a later date are made individually.

PREPARING FOR COLONOSCOPY

You need to prepare properly for the test. You can do this yourself at home and attend only for the test, without needing to be admitted to hospital.

Before colonoscopy, the bowel must be thoroughly cleared of digested food contents. Preparation involves taking a special laxative and following a strict liquid diet. This is not a pleasant process for the patient and requires discipline and strict adherence to the doctor’s instructions and the medicine’s package leaflet, but it is essential so that every part of the bowel lining can be inspected during the test. Preparation also depends on the time of day at which the test is performed.

 

• Colonoscopy preparation instructions using Fortrans for tests performed between 15-20 (document in Polish)
• Colonoscopy preparation instructions using Fortrans for tests performed between 9-15 (document in Polish)
• Colonoscopy preparation instructions using Eziclen for tests performed between 9-15 (document in Polish)
• Colonoscopy preparation instructions using Eziclen for tests performed between 15-20 (document in Polish)
• Patient declaration form before colonoscopy (document in Polish)

 

 

Description of the test

The Endoscopy Unit uses very modern colonoscopes, which are thoroughly cleaned and disinfected in fully automatic washer-disinfectors after every use. This ensures a clear image for the doctor during the test and safety for the patient. The test takes place in a DIAGNOSTIC AND TREATMENT room adapted for this type of examination. It has a bathroom for the exclusive use of the patient being examined. After going to the bathroom, where you should undress from the waist down and cover yourself with a special gown, you will be positioned on your side on the procedure table.

Colonoscopy is usually preceded by a digital rectal examination. This allows the doctor to assess anal sphincter tone and how thoroughly the bowel has been cleared, and sometimes to detect disease in the lower rectum at this stage. The colonoscope is then gradually passed through the anus and rectum into the colon, and sometimes also into the final section of the small bowel. A special device at the tip of the colonoscope transmits images to a monitor, allowing the doctor to view the inside of the bowel. The flexible, narrow instrument allows all areas of the large bowel to be reached and its entire surface to be viewed. If you wish, you can follow the test with the staff on a monitor within your view. The inside of the bowel is assessed in detail as the colonoscope is withdrawn. If abnormalities are found, samples are taken using delicate instruments passed through the working channel of the device. The samples are sent for microscopic examination. Sometimes suspicious lesions are removed completely from inside the bowel during colonoscopy, if their type, size and location allow this. Many polyps are removed in this way. Unfortunately, not all lesions can be removed endoscopically. If the test reveals polyps and the doctor considers that they can be removed safely and immediately, special forceps or a diathermy snare will be used to remove them from the mucosal surface. However, if a lesion is large, the doctor often decides only to take a few small tissue samples. All tissue samples and polyps collected will be sent to the laboratory for histopathological assessment.
Colonoscopy is usually very well tolerated by patients. This depends, among other things, on the individual pain threshold, the patient’s health and their willingness to cooperate with the doctor during the test. It rarely causes severe pain. The test requires air to be pumped into the bowel to create space for the instrument to move safely. This causes a rather unpleasant feeling of bloating, distension and abdominal cramps. However, you should pass the excess wind when instructed by the doctor, as this brings considerable relief and allows the test to continue. The test usually takes between 15 and 60 minutes (for example, if lesions need to be removed). The feeling of bloating and fullness passes after passing wind. Immediately after the test, you can eat normally according to your preferences, return to your daily tasks and resume full everyday activity.

The test can be performed under general anaesthesia (separate appointments are available for this, as an anaesthetist and an anaesthetic nurse must be present and spaces in the recovery room must be reserved). After an intravenous medicine to induce sleep is given, you will fall asleep for around a dozen or so minutes and wake up once the test has finished. This is light anaesthesia and does not require insertion of an endotracheal tube. After the test, you may only start eating easily digestible food from the time specified by the anaesthetist. If the test is performed under general anaesthesia, you should arrange for someone to collect you from hospital approximately 2 hours after you arrive for the test. You must not drive for at least 12 hours after anaesthesia.

The test is safe, but like any medical procedure it carries a small risk of complications. These include bowel perforation, bleeding and infection. However, the complication rate is estimated to be below 1%. It is important not to ignore abdominal pain, fever with chills or rectal bleeding after the test, and to go to the nearest hospital as soon as possible if these symptoms occur.

Test results

You will receive the endoscopy report shortly after the procedure. The doctor will also provide recommendations for further management.