Colonoscopy Colonoscopy Is a Procedure to Look at the Inner Lining of Your Large Intestine (Colon)

Patient Education Partners in Your Surgical Care© American College of Surgeons Division of Education Colonoscopy Colonoscopy is a procedure to look at the inner lining of your large intestine (colon).

Patient Education This educational information is provided to make you more informed and to empower you with the skills and knowledge needed to actively participate in your care. Keeping You Informed Information that helps you understand your procedure and role in healing. Education is provided on: Procedure, Screening versus Therapeutic ...... 1 Benefits and Risks...... 2 Expectations and Recovery...... 3 Reasons for a For More Information...... 4 Colonoscopy Colonoscopy Screening Colonoscopy  Most colorectal cancers start as For strictures (narrowing or A flexible lighted tube fitted with a tiny non-cancerous polyps (fast growing partial blockage of colon), a video camera on the end is inserted cells that line the inside of the balloon is inserted through the into the rectum. The inside of the colon and may become cancer). endoscope and is inflated inside rectum and entire colon can be viewed A screening colonoscopy can the colon. This process widens for polyps, cancer, or diseases such as find and often remove the polyps the stricture. If needed, a small ulcerative colitis or Crohn’s disease. before they develop into cancer. If stent (tube) may be left in the cancer is already present, finding narrowed area to keep it open. it early, before it causes symptoms Surveilance colonoscopy or spreads, can increase your  chances of a full recovery.1,2 Follow-up for patients with a history of colon polyps, cancer, Therapeutic Colonoscopy3 or inflammatory bowel disease.  A therapeutic colonoscopy is performed to treat a known Other Procedure problem, such as cancer, polyps, or bleeding. Options  A biopsy (tissue sample) is taken (see glossary) with tiny forceps that grab and  Sigmoidoscopy trap small pieces of tissue.  Virtual colonoscopy (colonography)  Polyps may be removed with  Barium enema a wire snare or forceps.  Fecal occult blood  For bleeding, your doctor may seal  off the bleeding site by injecting DNA stool test medication, heat treatment, or clipping the bleeding site.

American College of Surgeons • 633 N. Saint Cl air St. • Chicago, IL 60611 • www.facs.org American College of Surgeons • 633 N. Saint Cl air St. • Chicago, IL 60611 • www.facs.org 1 Colonoscopy Benefits and Risks

Keeping You Benefits A colonoscopy is the most accurate way to find and remove small Informed polyps and get a biopsy. If you do not have a colonoscopy, polyps or cancer may not be identified until a more advanced stage. 4,5 Reasons for a Screening Colonoscopy  Starting at age 50, for Risks persons with average Your doctor will do everything possible to decrease risks, but risk, the American Cancer colonoscopy and sigmoidoscopy, like all procedures, have risks. Society recommends a colonoscopy every 10 years or sigmoidoscopy every 5 years and screening for The Risk What Happens Keeping You Informed fecal occult blood (blood in your stool) every year. A Perforation Perforation (hole that passes Management of perforation colonoscopy can prevent 76% through the entire wall of the depends on the size, whether to 90% of colon cancer.1, 2 colon) is reported in 0 to 2 it’s noticed immediately or later,  The lifetime risk of developing per 1,000 procedures. The risk and how you are feeling overall. colorectal cancer is about can increase for therapeutic A large perforation noticed 1 in 19 (5.4%). The risk procedures. Pressure from immediately requires surgery. the scope, a tear when air is A perforation noticed several is slightly higher for men. inserted, and polyp removal days later is treated by rest, Regular exercise, maintaining can cause perforation. 6-12 intravenous fluids, antibiotics, a healthy weight, eating and close observation. It may fruits and vegetables, also require an operation. and limiting alcohol Call your doctor if you have consumption may decrease fever, abdominal tenderness, your risk of colon cancer. or shortness of breath. 3  The risk for colon cancer is increased if you have Bleeding Bleeding is reported in 0 to 4 A trace of blood is normal. If ulcerative colitis, or Crohn’s per 1,000 procedures. The risk there is over 4 tablespoons disease, or a mother, father, or is greater with large of bleeding, call your doctor 6-9 sibling with colorectal cancer 4 polyp removal. immediately. You will be watched carefully and may 2 be given blood. Surgery Sensitivity of tests is rarely necessary.  Fecal occult blood testing has Complications during the Cardiorespiratory complications a sensitivity of 40%–60% Cardiorespiratory procedure can include irregular are usually related to medicine when done on a yearly basis. heart beat (1 per 1,000), given to keep you comfortable This means that if 10 people low heart rate (8 per 1,000), during the procedure. Your had colon cancer, this test low blood pressure (12 per doctor will monitor your heart would show positive blood 1,000), low oxygen levels rate, breathing, and oxygen in 4–6 of the 10. The others (56 per 1,000), and heart levels. Oxygen and intravenous would have cancer, but it attacks and stroke (fewer fluids will be given if needed. would not be detected. than 1 per 1,000). 6-9  Sigmoidoscopy has a sensitivity of 70%–80%, Death No deaths are reported for There is a small risk of but can only identify polyps screening or therapeutic death (1 per 10,000) with a colonoscopy since 2000.6-11 therapeutic colonoscopy (a or tumors in the lower half colonoscopy for treatment of the colon and rectum. of disease or bleeding).6-12  Colonoscopy has a sensitivity of 90%.

 American College of Surgeons • 633 N. Saint Cl air St. • Chicago, IL 60611 • www.facs.org American College of Surgeons • 633 N. Saint Cl air St. • Chicago, IL 60611 • www.facs.org Colonoscopy Expectations and Recovery

and it is recommended that you do Before the procedure not make any big decisions, drive, or Pre-colonoscopy evaluation includes return to work for the rest of the day. Keeping You your history, current medications, Diet—Though you may be eager to eat and allergies. It is important to let Informed after fasting, it is a good idea to start your doctor know if you are taking Your medicine with soft foods for your first meal. any blood thinners (Plavix, aspirin, If you take medication each day, coumadin) vitamins, herbs, or iron. Pain—Severe pain is rare after ask your doctor what medications the procedure. 6,7 You may have Bowel preparation—The bowels need you should take on the day of minor cramping and gas after the to be clean (removed of food and stool) the procedure. Usually you will procedure. After you pass gas, before the procedure. You should only take your regular medication the cramping should be gone. drink clear liquids (examples include with a small sip of water. broth, apple juice, and tea) for 12 Bowel movements—You should return to 24 hours before your test. Drink to your normal bowel movement pattern Safety check nothing 4 hours before your test. If within 2 to 3 days after your procedure. If you are having the procedure stool is left in the bowel, your doctor done in a hospital or ambulatory If you had a biopsy or polyps removed, may have to reschedule the test. center, an identification your doctor will let you know: Preparation Instructions bracelet with your name will  when and how you will be be placed on your wrist. This Carefully follow the prep instructions informed about your results. should be checked by all health provided by your doctor.  if you need to avoid aspirin, care team members before ibuprophen, or other blood thinners providing any procedure or The day of your for 10–14 days after the procedure. giving you medication. procedure When to Call Your Doctor Sedation If you receive sedation or You will be placed on your side and given Call Doctor ______at anesthesia for your procedure, medicine, through an intravenous line to ______if you have: talk to your doctor about the help you relax. You will lie on your side,  severe abdominal pain or if your type of sedation and side usually with your knees drawn towards abdomen feels hard–this could be effects. Common drugs include your chest. Your doctor will guide a scope a symptom of colon perforation. benzodiazepines (midazolam/ that is inserted into the anus and passed  bleeding for more than 2 bowel Versed), opioids (Fentanyl), up through the colon. Small amounts of movements or bright red bleeding and other agents (Propofol).13 air are inserted to open the colon and that fills a shot glass allow viewing of the surrounding area.  If sedated, you will be monitored The tube has a light and camera at the fever greater than 100.4º F (38º C ) by your doctor and another  end and sends pictures to a TV screen. swelling, redness, or drainage health care provider. A clip will at the intravenous site be placed on your finger that Your heart rate, breathing, and  weakness, shortness of will measure your heart rate oxygen level will be monitored during breath, or fainting and oxygen levels. Your blood the exam. The procedure will take  pressure and heart activity about 20 to 60 minutes. If your doctor nausea or vomiting blood may also be monitored. sees abnormal tissue or polyps, they may be removed or biopsied. Your recovery Other Instructions: You will be monitored until you are fully awake. Without complications you are usually discharged home Follow-Up Appointments within 30 to 90 minutes. Who Date Phone If you receive sedation or relaxation medication you will need someone to drive you home. You may feel groggy

American College of Surgeons • 633 N. Saint Cl air St. • Chicago, IL 60611 • www.facs.org American College of Surgeons • 633 N. Saint Cl air St. • Chicago, IL 60611 • www.facs.org  Colonoscopy For More Information

For more information, please go to the Keeping you American College of Surgeons Patient Education Informed Web site at www.facs.org/patienteducation/ Glossary Barium enema is a procedure The information provided in this brochure is chosen from recent articles where barium (liquid dye) based on relevant clinical research or trends. The research listed below does is put into the rectum and not represent all of the information that is available about your procedure. colon. X rays are then taken 1. Winawer S, Fletcher R, Rex D, et al. Colorectal cancer screening to find any abnormal areas. and surveillance: Clinical guidelines and rationale-update based on new evidence. Gastroenterology 2003;124(2):544-560. Crohn’s Diesease is an 2. Pignone M, Rich M, Teutsch, et al. Screening for colorectal cancer in inflammatory bowel disease that adults at average risk: A summary of the evidence for the US Preventative causes swelling and ulcers of the Services Task Force. Annals of Internal Medicine. 2002;137(2):132-141. entire gastrointestinal system. 3. Fanning A, Ponsky J. 2006. Gastrointestinal endoscopy. In W Souba, DNA stool test is a screening M Fink, G Jurkovic, et al. ACS Surgery 2006. Web MD. test to check stool for genetic 4. Lieberman DA, Weiss DB, Bond JH, et al. Use of colonoscopy to screen DNA markers associated asymptomatic adults for colorectal cancer. Veterans Affairs Cooperative with colorectal cancer and Study Group 380. New England Journal of Medicine. 2000; 343:162. precancerous polyps. A whole 5. ASGE, SAGES. Colonoscopy in the screening and surveillance of bowel movement (stool) individuals at increase risk for colorectal cancer. Available at http:// www.sages.org/sg_asgepub1030.html. Accessed March 2007. is collected in a container 6. Bowles CJA, Leicester R, Romaya C, et al. A prospective study of and sent for testing. colonoscopy practice in the UK today: Are we adequately prepared for Fecal occult blood test is a test national colorectal cancer screening tomorrow? Gut. 2004;53:277-283. to check stool for blood. Small 7. Viiala CH, Zimmerman M, Cullet DJ, et al. Complication rates of colonoscopy in an swabs of stool are placed on Australian teaching hospital environment. Internal Medical Journal. 2003;33:355-359. a special card and brought 8. Wexner SD, Garbus JE, Singh JJ. A prospective analysis of 13,580 to a doctor for testing. colonoscopies. Surgical Endoscopy. 2001;15:251-261. 9. Seig A, Hachmoeller-Eisenbach U, Eisenbach T. Prospective evaluation Sigmoidoscopy is a procedure of complication in outpatient GI endoscopy: A survey among German which views only the gastroenterologists. Gastrointestinal Endoscopy. 2001;53(6):620-7. inside of the rectum and 10. Tran DQ, Rosen L, Kim R, et al. Actual colonoscopy: What are the sigmoid (lower) colon. risks of perforation? The American Surgeon. 2001;67:845-8. Ulcerative colitis is a disease that 11. Anderson ML, Pasha TM, Leighton JA. Endoscopic perforation of the colon: Lessons causes inflammation (redness from a 10-year study. The American Journal of Gastroenterology. 2000;95(12):3418-22. and swelling) of the colon and 12. Nelson DB, McQuaid KR, Bond JH, et al. Procedural success and complication of possible bloody diarrhea. large-scale screening colonoscopy. Gastrointestinal Endoscopy. 2002;55(3):307-14. 13. Faulx AL,Vela S, Das A, et al. The changing landscape of practice Virtual colonoscopy patterns regarding unsedated endoscopy and propofol use: A national (colonography) is a special Web survey. Gastrointestinal Endoscopy. 2005;62:9-15 computed tomography (CT) Reviewed by: H. Randolph Bailey, MD, FACS scan with the colon filled with David Schoetz, MD, FACS air. The scan may show polyps Kathleen Piotrowski-Walters, RN, MSN and other abnormalities on the inside of the colon. It is less This information is published to educate you about your specific surgical procedures. It is not intended to take the place of a discussion with a qualified surgeon who is familiar with accurate than a colonoscopy and your situation. It is important to remember that each individual is different, and the reasons does not allow for treatment of and outcomes of any operation depend upon the patient’s individual condition. The American College of Surgeons is a scientific and educational organization that is dedicated polyps or other abnormalities. to the ethical and competent practice of surgery; it was founded to raise the standards of surgical practice and to improve the quality of care for the surgical patient. The ACS has endeavored to present information for prospective surgical patients based on current scientific information; there is no warranty on the timeliness, accuracy, or usefulness of this content. © 2008 American College of Surgeons

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 American College of Surgeons • 633 N. Saint Cl air St. • Chicago, IL 60611 • www.facs.org Colonoscopy Colonoscopy Preparation Instructions GoLYTELY® Solution

Appointment Date: Appointment Time: Location:

If you have any problems completing the instructions, call:

7 Days before the One Day before the procedure: The Day of the procedure:  Early in the morning Procedure:  Fill your prescription for  You can eat a low fiber breakfast (eggs,  Take your normal GoLytely Prep. This will be white bread, yogurt without fruit) medications with a gallon jug with powder mix  Prepare your GoLYTELY a sip of water. inside. Do not add any water  Fill the plastic container with  Stop drinking clear to the container until the warm water. Shake well until liquids 3 hours day before your colonscopy. the powder is dissolved. Place the before the procedure.  Stop taking iron, container in the refrigerator (it  Bring your escort/ vitamin E, ginkgo, ginger, tastes better when it’s cold). driver with you to garlic, and aspirin.  Start drinking 8 to 10 glasses of clear your appointment.  Talk to your doctor or nurse liquids (clear liquids are drinks that you  Arrive 30 minutes if you are taking blood can see through when in a clear glass).  before your thinners (Coumadin, Plavix, Juice (apple, white grape) appointment time. Ticlid, Agrylin); you may  Beef, chicken, or vegetable broth need special instructions  Tea and coffee (without milk) (See the manufacturers if you take insulin or other  Clear soda, Gatorade, Kool-Aid (avoid red) label with your diabetic medication. GoLYTELY  Popsicles and Jello prescription.)  Between 4:00–6:00 pm  Start drinking the GoLYTELY  Drink one 8-ounce glass rapidly 3 Days before the every 10 minutes (try not to sip). procedure:  If you feel bloated (full stomach) or nauseated, drink each portion  Stop taking all aspirin and more slowly and, if you need to, antiinflammatory medicine take a 20 to 30 minute break. (Anacin, Advil, Aleve,  Alka Seltzer, Bufferin, Finish the entire gallon Ecotrin, ibuprophen, Motrin, in 3 hours or less. Naprosyn, Nuprin, Voltaren,  You can continue to drink other Relafen). You can still take clear liquids in between or after acetaminophen (Tylenol). drinking the GoLYTELY.   Stop eating seeds, nuts, You will begin to have loose stools within 1 to 2 corn, popcorn, high hours after you start drinking the GoLYTELY.  fiber foods/cereal, and To decrease the discomfort and skin whole grain breads. irritation around the rectum use wet Patient Education wipes instead of toilet paper and place  Review your diet and Vaseline around the rectum. Partners in Your purchase a variety of clear liquids. Surgical Care

American College of Surgeons • 633 N. Saint Cl air St. • Chicago, IL 60611 • www.facs.org