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What is it about ?
Colonoscopy (or colonoscopy) is an examination that allows you to view the inside of the large intestine (colon) and the last part of the small intestine using a flexible tube fitted with a camera (an endoscope), that is inserted through the anus.
This tube also allows the introduction of instruments to, for example, remove polyps, take a piece of tissue (biopsy) from the intestine for further examinations or to stop bleeding.
Sigmoidoscopy is a similar test, but is limited to the rectum or sigmoid colon (the last part of the large intestine). For this examination, the endoscope is inserted approximately 50 cm.
This type of examination lasts approximately 20-25 minutes. Colonoscopy or sigmoidoscopy is usually performed in day hospitalization. It is often done under a light anesthesia, which means that you are awake, but slightly knocked out. After the exam, you are not allowed to drive. You must therefore organize your transport in advance.
When should a colonoscopy (or sigmoidoscopy) be done?
Sigmoidoscopy is reserved for a few very specific cases (for example when colon cancer is very unlikely) or for the follow-up or treatment of previously detected abnormalities.
Reasons justifying a colonoscopy:
- anal bleeding: colonoscopy is routine in people over 50; in younger children, an examination of the rectum (rectoscopy) is usually sufficient if there is a suspicion of anal fissure or hemorrhoids.
- anemia due to iron deficiency of unknown origin.
- blood in the stool, shown by a laboratory test (including if it is not visible to the naked eye).
- chronic diarrhea: if inflammatory bowel disease is suspected (inflammation of the rectum, ulcerative colitis or Crohn’s disease).
If you have stomach or bowel problems that suggest a problem in the small intestine, you start with an examination of the stomach (gastroscopy). Ditto in case of black stool (melena). The colonoscopy will only be performed later if the doctor considers it necessary.
A colonoscopy can also be used as a follow-up exam:
- after removal of a benign tumor or cancer,
- in case of hereditary colorectal cancer or familial polyposis,
- in case of chronic inflammation of the colon, given the increased risk of cancer,
- to assess the activity and extent of chronic inflammation of the colon with accompanying symptoms.
When should a colonoscopy (or sigmoidoscopy) be avoided at all costs?
Colonoscopy (or sigmoidoscopy) is not indicated:
- in case of flare-up of inflammation of the swellings of the large intestine (diverticulitis);
- in case of suspected perforation of the wall of the intestine;
- in a seriously ill person, the examination should be limited to the easily visible part of the intestine.
How do you know when a colonoscopy or sigmoidoscopy might be indicated?
Contact your GP if you have (had) anal bleeding, if you have diarrhea and persistent stomach pain and / or if you experience a change in the appearance or rhythm of your stools, particularly if you have more than 50 years old or if you have a family history of colorectal cancer or polyposis.
How does the doctor determine if a colonoscopy or sigmoidoscopy is indicated?
Depending on your complaints and your (family) history, the doctor will not only perform a physical examination, but also a stool and / or blood test. Sometimes these tests reveal the need for a colonoscopy (or sigmoidoscopy).
What can you do to prepare for a colonoscopy?
The colon should be clean. You are therefore not recommended to eat berries, vegetables that contain seeds and flax seeds the week before the test. Some centers recommend a low-fiber diet (residue-free diet) and ask you to take laxatives the day before the test.
From the evening before the day of the exam, only water is allowed.
On the morning of the colonoscopy, you should drink 3-4 liters of polyethylene glycol over a 3-4 hour period. During the first hour, the contractions of the intestines (peristalsis) accelerate and diarrhea occurs. The examination can take place when the discharged liquid is (almost) transparent.
A sodium phosphate enema is a good alternative to polyethylene glycol enema. It is an enema, injected through the anus, which stimulates the intestine in such a way that it triggers a need to have a bowel movement after fifteen to thirty minutes.
You must stop certain medications: iron supplements (7 days before the exam) and anticoagulants. Stopping anticoagulants should always be done in consultation with the doctor and specialist (s) depending on the risk of complications associated with stopping treatment.
What are the potential complications ?
Complications are rare. If you develop stomach pain, anal bleeding, fever, or chills, you should urgently contact the doctor who performed the exam. Possible complications are, for example:
- a perforation of the wall of the intestine requiring intervention,
- bleeding, which the gastroenterologist can usually stop through the endoscope. Hospitalization is sometimes necessary to keep you under surveillance and possibly to give you blood. The need for surgery is exceptional.
- very rarely: an infection or problem with the lungs or heart.
Want to know more?
- Colonoscopy – Erasme Hospital
- Colorectal cancer screening (video) – Fondation contre le cancer
- Colorectal cancer – Cancer Foundation
Sources
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