Diagnostic and therapeutic

1. Identification and description of the procedure

The colonoscopy is a visual exploration of the colon mucous (large intestine). Consists in the insertion of a flexible optic probe in the anus after an adequate preparation. The exploration usually lasts between 15 and 60 minutes. With the patient lying down on their left side, a digital rectal examination is performed usually with an anaesthetic cream. Afterwards, the endoscope is inserted and is made to progress through the colon, sometimes even to the last section of the small intestine. With the insertion you may notice spasms or abdominal pressure due to the necessary insufflations of air during the exploration or when passing through the characteristic angles of the colon. It is a normal thing that quickly disappears. In determined circumstances and always under the recommendation of the specialist doctor it can be performed under deep sedation. If this is the case, you will remain in the hospital for some time until the effects of the medication administered disappears and you must not drive as your reflexes may be altered.

2. Purpose of the procedure and benefits that are expected to be achieved

Diagnose the diseases of the digestive segment explored and treat them if possible during the same exploration. This way, if polyps are found during the they can be extirpated (polypectomy) with a noose that cuts around its base. If there is narrowing it can be dilated and even leave a prosthetic placed. If a bleeding lesion is found a treatment that ceases the bleeding can be applied. To able to reach a diagnosis in most of the cases, either by a direct visual of the lesions or thanks to the microscopic study of small tissue samples (biopsy) taken without pain during the exploration. To know the benign or malignant nature of the found lesions. It is possible to extirpate polyps during the same act and avoid an operation. Their recuperation of these after the exploration allows their microscopic study. Due to the suspicion or evidence of bleeding the lesions that cause the haemorrhage can be identified and permit to be acted on, avoiding operations and transfusions. If there is narrowing you will not benefit from an intervention as they can be widened by diverse methods, utilizing bougies or pneumatic balloons, placing prosthetics, etc.

3. Reasonable alternatives to this procedure

In the diagnosis field, the alternative is the radiography exploration by contrast enema or opaque enema. This can detect some lesions, but does not assure the benign or malignant nature of the found lesions, nor does it appreciate superficial or small lesions. This is why, the radiographic exploration does not always avoid a posterior colonoscopy to resolve any doubts. In each haemorrhage case, a detected lesion on the radiography does not assure that this is the cause of the bleeding. The alternative to the therapeutic endoscopy is , with a higher risk.

4. Foreseeable consequences of its performance

The correctly recommended colonoscopy will try in the majority of cases to assure a diagnosis which will be able to be treated better and better follow-ups. It is the only procedure able to diagnose colon in an early stage which carries a more favourable prognosis.

5. Foreseeable consequences of its non performance

Logically it is going to suppose a diagnostic in-exactitude in some cases, with an inadequate treatment and in others ignore the existence of some potentially serious lesions.

6. Frequent risks

Despite the proper choice of technique and its proper performance, undesirable side effects may arise such as pain due to abdominal distension, dizziness, hypertension, infection or arrhythmias. We must also mention the smaller risks that could be derived from the usage of laxatives or cleaning enemas previous to the exploration. SPECIALITY IN DIGESTIVE PATHOLOGY The haemorrhage or perforations are very infrequent (less than 1 of every 1,000 explorations). When therapy is practiced during the exploration this slightly elevates the risk. Diagnostic and therapeutic colonoscopy

7. Infrequent risks.

The need of deep sedation or general anaesthesia carry added risks such as respiratory depression or cardiovascular disorders. The risk situation of every patient will be evaluated by the anaesthesiologist whose cooperation may be necessary. Exceptionally we can observe arrhythmias or cardiac arrests, respiratory stop or depression, acute cardiovascular accident which can be serious which adds a minimal mortality risk.

8. Risks depending on the patient's clinical situation

A higher risk can occur with: the possible allergies to medicines, cardiopulmonary diseases, diabetes, , hypertension, anaemia, existence of prosthesis, pacemakers, age, altered coagulation or current medicines such as Aspirin, AA, Adiro, Disgren, Iscover, Tiklid... Any of these situations or if in doubt please advise your doctor.

Declaration of consent

Mr./Mrs./Miss. aged , with home address at , National Identity No. and SIP number

Mr./Mrs./Miss. aged , with home address at acting in the capacity of (the patient's legal representative, relative or close friend) , with National Identity No. Hereby declare: That the Doctor has explained to me that it is advisable/necessary in my situation to perform a and that I have adequately understood the information he/she has given me.

In on , 2

Signed: Mr./Mrs./Miss. With National Identity Card No PATHOLOGY SPECIALITY IN DIGESTIVE Signed: Dr. With National Identity Card No Associate number

Revocation of the consent I hereby revoke the consent granted on the date of , 2 and I do not wish to carry on with the treatment that I hereby terminate on this date. In on , 2

Signed: The Doctor Signed: The patient

Associate number: