Colonoscopy Procedure
Colonoscopy is a medical procedure that allows Dr. Coovadia to visually examine the lining of your large intestine from the inside. This procedure often is performed to test for colon cancer and to check for pre-cancerous polyps, which can be removed at the same time. Dr. Coovadia uses a long, flexible tube called a colonoscope. This device, about as thick as a finger, has a video camera on its tip and sends images to a video monitor, where Dr. Coovadia can evaluate the colon lining, from the rectum up until the furthest most point – the caecum and terminal ileum.
Colon cancer ranks amongst the five most common cancers in South Africa. In the USA, 50,000 colon cancer associated deaths occur every year – this is despite an active colon cancer screening program. Increased awareness and prevention could save at least half that number. Colonoscopy is a screening test to catch cancer early - while it is still treatable. It is used to detect and remove colonic polyps which may develop into cancers in the future.
The procedure also can be used to evaluate the cause of such symptoms as rectal bleeding, abnormal weight loss, iron deficiency, chronic diarrhoea, and constipation. Colonoscopy has the advantage of allowing Dr. Coovadia the opportunity to biopsy and treat any suspicious areas seen within the colon at the same time.
A colonoscopy is only as good as the bowel preparation. Good bowel preparation allows Dr. Coovadia to fully visualize the inner lining of the colon (the mucosa), allowing him to detect early, subtle mucosal changes - thereby allowing for early intervention (if required). You will be provided with clear instructions on how to correctly start your preparation. The instruction sheet will explain the dietary restrictions and the cleansing routine you need to follow prior to your procedure. Preparation instructions are individualized to allow for a proper cleaning if your colon prior to your endoscopy. Should you have any concerns or queries related to your preparation for your colonoscopy, please do not hesitate to contact Dr. Coovadia’s team for further advice.
Please inform Dr. Coovadia and the anaesthetist if you are currently taking any medications — particularly insulin, antiplatelet products (aspirin/clopidogrel), anticoagulants (such as blood thinners like warfarin, Xeralto or heparin), arthritis medications, iron supplements. Also please inform the medical team about any medication allergies you may have.
You should continue to take your medications as usual unless Dr. Coovadia specifically instructs you not to. Some medicines can interfere with your preparation or with the examination.
For many, entering the endoscopy theatre can be a very daunting experience. Be rest assured that your endoscopy team prides itself on patient comfort and safety. You will be attached to cardiac and respiratory monitors, which will be monitored throughout the procedure. Your anaesthetist will administer sedation, which will allow you to better tolerate your colonoscopy. Whilst a colonoscopy should not be painful, air is insufflated (blown) into your colon. This can result in a sensation of bloating or abdominal pressure and is short-lived.
You will be positioned on your side or on your back while the Dr. Coovadia slowly inserts the colonoscope into your rectum and advances it along your large intestine to examine its lining (mucosa). You may need to be re-positioned during the procedure. Dr. Coovadia makes use of handheld controls to advance the colonoscope safely to the end of the colon. He will further examine the lining of your colon (mucosa) again as he withdraws the colonoscope from the colon. While examining the lining of your colon (mucosa), should Dr. Coovadia encounter an abnormal area of mucosa or a polyp, he will biopsy this area or remove the polyp painlessly.
The procedure usually takes 30 minutes depending on whether an intervention (biopsy, polypectomy, treatment of a blooding blood vessel) is required.
Following your colonscopy, Dr. Coovadia will discuss the findings with you prior to your discharge from hospital. A normal colonoscopy is re-assuring and will be used as a baseline for comparison for future endoscopies. If you are over 45 years of age with no history of colon cancer, you should continue with screening colonoscopy during the surveillance period Dr. Coovadia recommends.
If Dr. Coovadia finds an area that he wants to further evaluate, he will pass instruments through the colonoscope to retrieve a biopsy — a small tissue sample — to have analysed. Biopsies can help identify many conditions, such as Crohn’s disease, Ulcerative colitis, infective colitis, polyps, and colon cancer.
Dr. Coovadia will look specifically for polyps during your colonoscopy. Polyps are abnormal growths in the colon lining (mucosa) that vary in size from a tiny dot to several centimetres. They usually are non-cancerous, but he will remove them, by using a snaring device (snare polypectomy) during the colonoscopy and send them to the laboratory for analysis. Because cancer begins in polyps, removing them is a first step toward preventing colon cancer. You will not feel any pain during this process.
While the sedatives wear off after the procedure, our nursing staff will monitor your recovery. You may experience some minor cramping or bloating due to air introduced into your colon during the examination, but it should pass quickly. Before you are discharged, Dr. Coovadia will explain the findings of your colonoscopy. Your biopsy results will be shared with you as soon as Dr. Coovadia receives them from the pathologist – This usually takes 48-72 hours.
As you have been given sedatives for your colonoscopy, you must have someone drive you home and stay with you before you can be discharged. Even if you feel alert, your judgment and reflexes may be impaired for the next 24 hours. You will be given a meal after the procedure.
Colonoscopy and polypectomy are safe procedures when performed by trained and experienced gastroenterologists like Dr. Coovadia. Complications are rare, but the most severe complication is a perforation of your colon lining. This may require surgery to repair.
Other complications include minor bleeding from the site of a biopsy or polypectomy. The bleeding often stops by itself, and Dr. Coovadia will ensure that there is no active bleeding, prior to removing the colonoscope.
Symptoms from complications include severe abdominal pain, fever, chills, or rectal bleeding (although minor bleeding may last for several days after the procedure without being dangerous). While these complications are uncommon, you should contact Dr. Coovadia or the Mediclinic Panorama Emergency Centre immediately if you notice them.