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Preparation for Colonoscopy

Preparation before colonoscopy is essential for a correct result. Doctor's recommendations

After the age of 50, everyone should have a colonoscopy as a routine investigation. Those with a family history of colon cancer, as well as those with inflammatory bowel disease, should have this screening method, used to detect changes or abnormalities in the large intestine (colon) and rectum, earlier.

Colonoscopy can also be a method of treatment, not just diagnosis. Specifically, during the investigation, if necessary, polyps on the colon or other abnormal tissue can be excised. Tissue samples may also be taken during colonoscopy for analysis.

 

What is colonoscopy

“Colonoscopy is the main recommended investigation to detect any disease in the colon. In addition, it is the most important colon cancer prevention exam.”

Dr Camel Kopty, internal medicine physician with expertise in gastroenterology, endoscopy and hepatology at the Wiener Privatklinik Hospital in Vienna.

Your doctor may recommend a colonoscopy in the following situations:

  • To investigate gastrointestinal signs and symptoms. With colonoscopy, your doctor can explore possible causes of abdominal pain, rectal bleeding, chronic constipation, chronic diarrhoea and other intestinal problems;
  • for colon cancer screening. If you are over 50 and have no risk factors for colon cancer (other than age), your doctor may recommend a colonoscopy every 10 years. Sometimes a colonoscopy should be done earlier to screen for colon cancer. “If there is a family history of colon cancer, then the recommendation is to have it done earlier, starting at age 35,” says Camel Kopty, MD;
  • to screen for colonic polyps. If you have had polyps detected on your colon once, your doctor may recommend regular repeat colonoscopies to detect and remove other possible polyps. Excision of polyps reduces the risk of colon cancer.

In some situations, rectoscopy (investigation of the rectum) or rectosigmoidoscopy (endoscopic investigation of the rectum and lower colon) may be sufficient.

 

Special training is needed for colonoscopy

Nutrition is essential for pre-colonoscopy preparation. 7 days before the investigation, you should not eat foods rich in fibre (whole grains, fruit, legumes). In particular, it is advisable to avoid: cereals, lettuce and, in general, green leafy vegetables, red beetroot, red cabbage, tomatoes, cucumbers, grapes and citrus fruit.

 

Foods allowed before colonoscopy

Four days before your colonoscopy, you can eat the following foods, in small quantities:

  • yoghurt,
  • strained soup,
  • cottage cheese,
  • lean meat, boiled or grilled,
  • white bread (without seeds).

 

When enema is needed

It is important to empty your bowels like this before the colonoscopy:

Following a special diet the day before the investigation. Usually you will not be able to eat solid food the day before. Drinks can be limited to clear liquids – plain water, tea and coffee without milk or cream, no broth or tomato juice and no carbonated drinks. Avoid red liquids, which can be mistaken for blood, during colonoscopy. In some cases, doctors recommend not eating or drinking anything the night before the investigation.

Administering laxatives. Usually, your doctor will recommend that you take a laxative, either in pill or liquid form. Take it the night before the procedure or both the night before and the morning of the examination.

Using an enema kit. In some cases, you may need to use an enema kit that is available without a prescription. Enema is performed either the night before the examination or a few hours before the investigation – to empty the colon. This is generally only effective in emptying the lower colon and is usually not recommended as the primary way of emptying the colon.

In addition, it is necessary to inform your doctor if you are taking any medication as it may need to be adjusted.

 

How to do colonoscopy

Colonoscopy is done in a clinic or hospital in the presence of the specialist doctor and an anaesthetist, if the procedure is with partial or total anaesthesia of the patient. The total duration of the procedure is between 30 and 60 minutes.

During the colonoscopy, the patient will lie on their side with their knees bent to their chest. The doctor will then insert a thin tube into the anus, through the rectum and then into the colon. The doctor will expand the volume of the colon using carbon dioxide to get a clearer picture of its surfaces.

The video camera with which the colonoscope is equipped will play back the images inside the colon on a monitor and offer the opportunity to be recorded.

If the patient has undergone general anaesthesia, they will be fully awake about an hour after the procedure is completed.

 

Colonoscopy with anaesthesia eliminates discomfort

Anaesthesia for colonoscopy is performed intravenously by administering pain-relieving and relaxing substances. General anaesthesia or deep sedation may also be given, also by intravenous administration of substances that induce deep sleep.

If anaesthesia of any kind is chosen, the patient may not drive a car after the investigation and it is recommended to resume any activities only the next day.

After the procedure, you may feel bloated or gassy for several hours until all carbon dioxide is removed from the colon. Walking may help alleviate any discomfort.

Read the main myths about general anaesthesia, epidural and spinal anaesthesia debunked by your anaesthetist here.

You may also notice a small amount of blood at the first stool after the procedure. Usually this is not a cause for alarm.

Contact your doctor if you continue to notice blood or blood clots or if you have persistent abdominal pain or fever.

 

Colonoscopy results

Negative result

A colonoscopy is considered negative if the doctor finds no abnormalities in the colon.

In this situation, you may be recommended for a new colonoscopy at an interval of:

  • 10 years, if you have an average risk of colon cancer – you have no other risk factors for colon cancer besides age;
  • 5 years if you have a history of colon polyps;
  • 1 year, if there was residual stool in the colon that prevented a complete colonic examination.

 

Positive result

A colonoscopy is considered positive if the doctor finds polyps or abnormal tissue on the colon.

Most polyps are not cancerous, but some may be precancerous. Polyps removed during colonoscopy are sent to an immunohistochemistry laboratory for analysis. This is the only way to determine whether they are cancerous, precancerous or non-cancerous.

Depending on the size and number of polyps, more frequent evaluation may be necessary.

If the doctor finds one or two polyps on the colon smaller than 1 centimeter in diameter, he or she may recommend repeat colonoscopies every 5 to 10 years, depending on other risk factors for colon cancer.

You will be recommended another colonoscopy sooner if:

  • you have more than two polyps;
  • you have a polyp larger than 1 centimetre;
  • you have polyps on your colon and residual stool in your colon that prevents a complete examination of your colon;
  • you have polyps on your colon with certain cellular characteristics that indicate a higher risk of cancer in the future;
  • you have cancerous polyps on your colon.

If you have a polyp or other abnormal tissue that could not be removed during the colonoscopy, your doctor may recommend repeating the procedure with a gastroenterologist who is experienced in removing large polyps, but surgery may also be necessary.

 

Is a virtual colonoscopy useful?

“Only real colonoscopy, physically performed at the hospital/clinic, is a quality examination that really helps us to make a diagnosis. Virtual colonoscopy is not recommended.”

Dr Camel Kopty, Internal Medicine

Virtual colonoscopy is performed using an abdominal computed tomography (CT) scan. A special CT computer program allows the 3D reconstruction of the images obtained so that they are similar to a traditional colonoscopy. However, virtual colonoscopy is not recommended as a primary method of examining the colon. It is only done in situations where colonoscopy cannot be performed or if colonoscopy has produced incomplete results.

 

Colonoscopy price

A total colonoscopy costs between 400 and 500 Lei, depending on the clinic, plus the cost of anaesthesia (around 100 Lei) and the cost of any polyp removal (between 200 and 500 Lei, depending on the clinic and the number of polyps removed).

For a rectosigmoidoscopy, the cost varies between 250 and 370 Lei. For insured persons, colonoscopies can be done free of charge with a referral from the doctor.

 

The  Wiener Privatklinik is one of the largest private clinics in all of Austria! One of the things that speaks for us is the interdisciplinary cooperation of different specialties such as radiology, pathology, surgery, dermatology, medical oncology and radiotherapy!

Contact us today and learn more!

 

 

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