What is involved in a colonoscopy procedure and what are the associated risks?

From the Guidelines

A colonoscopy is a medical procedure that examines the large intestine (colon) and rectum using a flexible tube with a camera called a colonoscope, and before referring Tom for this procedure, it is essential to explain the risks involved, including bleeding, perforation, and adverse reactions to sedation, as reported in the most recent study 1. To explain the procedure to Tom, it is crucial to inform him that a colonoscopy typically involves a clear liquid diet for 24-48 hours and drinking a bowel-cleansing solution before the procedure. During the colonoscopy, which takes 30-60 minutes, patients receive sedation while the doctor inserts the colonoscope through the rectum to examine the colon lining, remove polyps, and take tissue samples if needed. The main risks associated with colonoscopy include:

• Bleeding, which occurs in about 14.6 per 10,000 colonoscopies, especially after polyp removal, as reported in the study 1
• Perforation, which occurs in about 3.1 per 10,000 colonoscopies, as reported in the study 1
• Adverse reactions to sedation, which can include cardiopulmonary events, although the precise frequency of occurrence is not known, as reported in the study 1
• Missed lesions, which can occur due to various factors, including the quality of the bowel preparation and the skill of the endoscopist. Most patients experience minimal discomfort, with some bloating or cramping afterward due to air introduced during the procedure. Recovery typically takes about an hour in the facility, and patients need someone to drive them home due to the sedation effects. It is also essential to inform Tom that the benefits of colonoscopy, including the detection and removal of precancerous polyps, can help reduce the risk of colorectal cancer, as reported in the study 1. Overall, the benefits of colonoscopy outweigh the risks, and it is a recommended screening test for average-risk adults between the ages of 50 and 75 years, as stated in the guidance statement 1.

From the FDA Drug Label

ASK A DOCTOR BEFORE USE IF YOU HAVE • nausea, vomiting or abdominal pain • a sudden change in bowel habits that lasts over 2 weeks • irritable bowel syndrome

The FDA drug label does not answer the question.

From the Research

Explanation of the Procedure

• A colonoscopy is a medical procedure that involves the use of a flexible tube with a camera and light on the end to visualize the inside of the colon and rectum 2.
• The procedure is typically performed to screen for colorectal cancer and to remove polyps or other growths from the colon 3, 4.
• During the procedure, the patient will be asked to lie on their side and the colonoscope will be inserted through the rectum and guided through the colon 4.
• The doctor will then use the camera and light to visualize the inside of the colon and rectum, and will remove any polyps or other growths that are found 2.

Risks Involved

• There are several risks associated with colonoscopy, including bleeding, perforation of the colon, and adverse reactions to the sedation used during the procedure 5, 2.
• The risk of bleeding is higher if polyps are removed during the procedure, and the risk of perforation is higher if the colon is weakened or damaged in some way 5.
• The risk of adverse reactions to sedation is higher in patients who have certain medical conditions or who are taking certain medications 2.
• It's also important to note that colonoscopy is not a foolproof test, and there is a small chance that polyps or other growths may be missed during the procedure 3, 6.

Alternatives to Colonoscopy

• There are several alternatives to colonoscopy, including computed tomography colonography (CTC) and virtual colonoscopy 5, 6.
• CTC uses a CT scanner to take pictures of the colon and rectum, and can be used to detect polyps and other growths 5.
• Virtual colonoscopy uses a combination of CT scans and computer software to create a virtual image of the colon and rectum, and can be used to detect polyps and other growths 6.
• These alternatives may be less invasive and less risky than colonoscopy, but may not be as accurate or effective in detecting certain types of polyps or growths 5, 6.