colonoscopy

Colonoscopy




Colonoscopy is a diagnostic and therapeutic method that allows accurate watching of colon mucosa, evaluating visual changes, taking a specimens for histopathological examination and removing of small pathological structures (e.g. polyps). To perform the colonoscopy is used a special type of endoscope called ‘colonoscope’ (this is a thin, flexible instrument with a camera that sends images to a monitor). The patient should be gear up for colonoscopy: 1-2 days before the planned procedure the patient starts a liquid diet with taking laxatives (e.g. phosphates). Purifying enema should be performed shortly before colonoscopy. The examination is unpleasant and painful - it is recommended to perform it with anesthesia (general or sedation). Time of the procedure is varied - the more difficult cases may exceed half an hour.


Types


We can distinguish a few types of the colonoscopy based on a range of procedure: anoscopy (examination of the anal and final rectum) , rectoscopy (rectal examination), rectoromanoscopy (examination of the distal part of the sigmoid colon), sigmoidoscopy (distal part of colon and sigmoid), rectosigmoidoscopy (end of the rectum and sigmoid colon) and colonoscopy (examination of complete colon).


Indications


The indication to perform a colonoscopy can be classified into two groups:

1. Therapeutic (small endoscopic procedures): polypectomy, preventing bleeding from abnormal structures (tumors, ulcers, vascular malformations), pulling foreign bodies out, stenoses dilatation, decompression of the worsening ulcerative colitis (megacolon toxicum).

2. Diagnostic (medical indication or screening): suspected of: colorectal cancer, ulcerative colitis, Crohn's disease, inflammatory bowel disease, absorption disorders; diarrhea of unknown origin, gastrointestinal bleeding suspicion (anemia), weight loss and screening of the population (early-stage colorectal cancer).

Contraindications


Peritonitis (abdominal tension and painful abdominal palpation), pregnancy (second and third trimester), coagulation disorders, severe heart disease (heart failure in advanced stage, unstable coronary artery disease), severe pulmonary disease, acute respiratory failure, worsening inflammatory bowel disease.

Complications


(less than 1%): perforation of the gastrointestinal tract and severe bleeding.

Tags

achalasia Adenocarcinoma adenoma banding bleeding cancer carcinoma cataract cataract surgery colon colonoscopy duodenum echocardiography emr endoscopy esophagus gastroscopy GIST hernia Histopathology laparoscopy laryngology lesion polyp polypectomy rectum stomach TUMOR ulcer varices
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Colonoscopy: Cecal Cancer

Gottumukkala Raju

Middle aged patient underwent colonoscopy and was found to have a cecal mass; biopsies revealed tubulovillous adenoma with high grade dysplasia, with some distorted glands. The patient came for a second...

views: 626 comments: 0

Colonoscopy: IC valve and cecum flat lesion...

Gottumukkala Raju

Middle aged patient with an IC valve polyp came in for endoscopic mucosal resection. The endoscopy report was confusing regarding the extent of the lesion. It is important to provide a detailed report...

views: 316 comments: 0

Colonoscopy: Transverse Colon Large EMR

Gottumukkala Raju

This video presents a resection of multiple sessille serrated adenomas in the transverse colon of middle aged patient

views: 405 comments: 0

Colonoscopy: Polyposis

Gottumukkala Raju

A video showing extensive polyposis from cecum to descending colon

views: 342 comments: 0

Colonoscopy: IC Valve Lesion Resection

Gottumukkala Raju

Following video presents a resection of an IC valve lesion. Procedure was technically challenging to perform because of fibrosis in the middle of the polyp

views: 263 comments: 0

Colonoscopy: Transverse colon EMR of a subtle...

Gottumukkala Raju

This video presents a resection of a subtle LST-NG lesion in the transverse colon in middle age patient. The procedure was conducted in general anesthesia. Piecemeal resection was focussed on the margin...

views: 277 comments: 0

Colonoscopy: Transverse Colon - Subtle Lesion

Gottumukkala Raju

Take time to carefully examine wall of the colon. Flat lesions are easy to miss as this one. During the initial exam, it was not seen until a detailed exam of the wall was made to detect subtle changes...

views: 263 comments: 0

Colonoscopy: EMR of a Rectal Cancer in an...

Gottumukkala Raju

A case of a middle aged patient with multiple colon cancers in the past, diagnosed with rectosigmoid polyp - notice the flat area suspicious for cancer (previous biopsies were benign). The lesion was...

views: 484 comments: 0

Colonoscopy: Ascending Colon Flat Lesion...

Gottumukkala Raju

A video presenting a resection of a flat lesion in ascending colon of elderly patient.

views: 336 comments: 0

Colonoscopy: First Webcast

Gottumukkala Raju

A first webcast by Gottumukkala S. Raju from his office, 13th floor, Pickens Tower, at the University of Texas MD Anderson Cancer Center.

views: 273 comments: 0

Colonoscopy: Ascending Colon Polyp - Large...

Gottumukkala Raju

Video presents a resection of 40 mm LST-G polyp. The procedure consisted of EMR, hemostasis, APC and clip closure. At first polyp was injected with 22 ml of saline with Methylene Blue and 6 ml of Epi,...

views: 303 comments: 0

Colonoscopy: Ascending Colon EMR - 2 hour...

Gottumukkala Raju

The following video shows a EMR of an ascending colon polyp. Whole procedure took 2 hours, video was edited to 30 minutes

views: 203 comments: 0

Colonoscopy: Rectum - Large Polyp Resection...

Gottumukkala Raju

This video presents a resection of large rectal polyp. Instruments: Half of the resection with an adult colonoscope and half with an EGD scope. Resection: Piecemeal EMR followed by hot biopsy avulsion...

views: 246 comments: 0

Colonoscopy: Descending Colon Polyp Resection...

Gottumukkala Raju

You can see the movement from diaphragm making the lesion move and consequently difficult to resect or apply APC precisely. In such cases, intubation and use of a short acting paralytic agent helps to...

views: 267 comments: 0

Colonoscopy: Rectosigmoid Giant Polyp Resection

Gottumukkala Raju

Middle aged patient was referred for endoscopic resection as an alternative to surgery. In his rectosigmoid colon a polyp with 5-6 cm head and a broad 2-3 cm stalk was found. The lesion was resected with...

views: 240 comments: 0

Colonoscopy: Sigmoid Colon Pedunculated...

Gottumukkala Raju

Patient: Middle aged patient was referred for endoscopic resection as an alternative to surgery. During colonoscopy a large pedunculated polyp in the sigmoid colon was found. Its volume was reduced by...

views: 251 comments: 0

Colonoscopy: Cecal Polyp Hot Biopsy Avulsion

Gottumukkala Raju

Elderly patient underwent serial colonoscopies every year for the last years with incomplete resection and APC of the cecal polyp (SSA), which resulted in tethering of the polyp and failure to lift with...

views: 324 comments: 0

Colonoscopy: Cecum EMR

Gottumukkala Raju

Video presented above shows a procedure of a cecal polyp resection.

views: 353 comments: 0

Colonoscopy: Cecal Flat Lesion EMR

Gottumukkala Raju

An elderly patient who survived sigmoid colon cancer underwent first surveillance colonoscopy. Cecum revealed a flat lesion that was removed by EMR + APC + Clip closure. Pathological examination showed...

views: 264 comments: 0

Colonoscopy: Cecal EMR - APC - Clips - Details

Gottumukkala Raju

A patient with medical history of a bladder cancer was dianosed with 3 cm cecal polyp. Patient was reffered to colonoscopy to avoid colon surgery. The procedure consisted of piecemeal resection followed...

views: 285 comments: 0

Colonoscopy: Large Rectal Polyp Resection

Gottumukkala Raju

A middle aged patient was referred to surgical department for low anterior resection. However, the lesionwas resected using endoscopic mucosal resection to avoid surgery.

views: 95 comments: 0

Colonoscopy: Rectosigmoid Colon Giant Polyp...

Gottumukkala Raju

A giant polyp occupying the whole rectosigmoid lumen was identified in a healthy person, who has neither symptoms nor family history of colon cancer, during screening colonoscopy. Polyp was resected...

views: 351 comments: 0

Colonoscopy: Ascending Colon EMR - Large...

Gottumukkala Raju

This video shows an EMR of a large sessile serrated adenoma in ascending colon of middle aged patient. At first, polyp was elevated by the injection, then the snare resection was performed. The APC was...

views: 218 comments: 0

Colonoscopy: IC valve flat lesion hot biopsy...

Gottumukkala Raju

During this procedure an IC valve polyp was resected. Snare resection turned out too difficult, even after injection, because of hard access to the lesion. Finally polyp was removed with hot biopsy avusion...

views: 195 comments: 0

Colonoscopy: Cecum Flat Lesion Resection

Gottumukkala Raju

This video presents resection of a flat polyp in cecum. The patient was turned during procedure to reveal the lesion submerged under the fluid. 15 mm snare was used to cut the lesion, followed by control...

views: 243 comments: 0

Colonoscopy: Cecum - EMR of a Subtle Flat...

Gottumukkala Raju

The following video presents a resection of a subtle flat lesion in the cecum. The main difficulty during procedure was injection of dye because of fluid, though rotating the patient to make the lesion...

views: 643 comments: 0

Colonoscopy: Giant Sigmoid Colon Polyp Resection

Gottumukkala Raju

A giant sigmiod colon polyp was referred for resection as an alternative to surgery During procedure multiple steps were involved: 1. Epinephrine volume reduction (inject epinephrine into the head and...

views: 507 comments: 0

Colonoscopy: Cecum - Subtle lesion - Sessile...

Gottumukkala Raju

Take time to examine as subtle serrated adenomas can be hiding in the cecum near the appendix in a pool of fluid as you see in this case.

views: 413 comments: 0

Colonoscopy: Transverse Colon Inflammatory...

Gottumukkala Raju

This video presents an excision of polyp with classic endoscopic features to suspect inflammatory polyp. Diagnosis was confirmed on histology

views: 292 comments: 0

Colonoscopy: Examination of Rectal EMR scar...

Gottumukkala Raju

Examination of large piecemeal EMR takes time - one needs to scan bit by bit for any subtle residual polyp using white light, NBI, and chromoendoscopy.

views: 266 comments: 0

Colonoscopy: Cecal EMR - Prior Failed Colonoscopy

Gottumukkala Raju

A colonoscopy performed in middle aged patient who had undergone CT colography after prior failed colonoscopy due to pelvic surgeries. Endoscope: Pediatric colonoscope failed to go above sigmoid colon;...

views: 281 comments: 0

Colonoscopy: Piecemeal EMR for management...

Gottumukkala Raju

This video shows a short presentation on the topic of piecemeal EMR for management of colon polyps

views: 300 comments: 0

Colonoscopy Demonstrating A Moving Worm

A 60-year-old woman presented to the outpatient clinic with vague abdominal discomfort that had developed over the previous several weeks. There was no abdominal tenderness. Laboratory evaluation was...

views: 1708 comments: 2

Diphyllobothrium Latum During Colonoscopy

A 46-year-old woman presented with a history of 3 days of pruritus in the anal area and 1 day of excretion of tapelike materials. During the year before presentation, she had reported intermittent colicky...

views: 1232 comments: 2

Colonoscopy: Sigmoid lipoma loop ligation

Gottumukkala Raju

A middle aged patient was referred endoscopic resection of a 6 cm pedunculated polyp with a broad stalk. Adult colonoscope was used. A large polyp was observed occluding the lumen. Epinephrine was injected...

views: 1004 comments: 1

Colonoscopy: Sigmoid Colon Polyp EMR

Gottumukkala Raju

The following video presents endoscopic mucosal resection for polyp in the sigmoid colon. The APC was used to prevent recurrence of the lesion and clip closure was performed to prevent delayed bleeding

views: 835 comments: 1

Colonoscopy: Snare Tip Cautery to Anchor...

Gottumukkala Raju

Lesion: Sessile serrated adenoma. Some times the snare keeps on slipping and prevents en-bloc resection. One can go for piecemeal resection in that case. Or, one could consider anchoring the snare tip...

views: 691 comments: 0

Colonoscopy: Ascending Colon Polyp Resection

Gottumukkala Raju

A case of a patient with large sessile lesion in the proximal ascending colon. The lesion had surface pit pattern and vascular pattern which are typical for benign polyps. The lesion was excised via...

views: 997 comments: 2

Colonoscopy: Appendicial Polyp Hiding Inside...

Gottumukkala Raju

The following video presents an appendix examination during colonoscopy. On first sight, the appendix looks apparently normal, but on close examination a serrated adenoma was noted.

views: 943 comments: 0

Endoloop Polypectomy

Georgios Mavrogenis

Step by step description of the resection of a pedunculated polyp located at the sigmoid.

views: 696 comments: 0

Resection of an Ileocecal Polyp

Georgios Mavrogenis

Resection of an adenomatous polyp located on the ileocecal valve with distal expansion behind the valve. In order to achieve en bloc resection the polyp was lifted with the coloscope (pediatric) in a...

views: 520 comments: 0

Colonoscopy Channel - Identification of...

Gottumukkala Raju

Subtle lesions, as serrated adenomas are hard to find. It is vital to focus on the wall of the colon for subtle signs of vessel cut off; also, the injection of Indigo Carmine helps to define the lesion,...

views: 735 comments: 0

Colonoscopy - Rectosigmoid Colon Underwater...

Gottumukkala Raju

An elderly patient was found to have a flat lesion in the rectosigmoid junction. Resection was difficult due to narrow lumen and he was referred to surgery. However, the patient opted for a minimally...

views: 865 comments: 0

Colonoscopy - LST NG Tumor - Difficult Resection

Gottumukkala Raju

LST-NG tumors are often difficult to resect, as they tend to have submucosal fibrosis. Also, it is vital to remove all of the lesion as such tumors are at high risk of harboring cancer. Here is a video...

views: 818 comments: 0

Colonoscopy Channel - Subtle Lesion in the...

Gottumukkala Raju

Detailed examination of the cecum is critical as shown in this video. Initially, a lesion was not visible; on repeat examination of the medial wall below the IC valve by using the cap, a polyp hiding...

views: 359 comments: 0

Colonoscopy Channel - Subtle Lesion in the...

Gottumukkala Raju

Colonoscopy screening involves careful screening of the colon. Rushing out of the colon results in overlooking of subtle lesions and an opportunity to prevent colon cancer will be missed. Here is a subtle...

views: 573 comments: 0

Colonoscopy Channel - Subtle Lesion at the...

Gottumukkala Raju

This video shows a screening colonoscopy in a middle age patient. A subtle lesion in the mouth of appendix is visible. Colonoscopy screening involves very careful screening of the colon. Rushing out of...

views: 736 comments: 0

Colonoscopy Channel - Ligation of a Giant...

Gottumukkala Raju

This video presents a giant lipoma of the colon. Endoscopic resection of such lesions results in a high risk of perforation. Loop ligation of a lipoma results in autoamputation and avoids the need for...

views: 834 comments: 0

Colonoscopy Channel - EMR of a Large Hemicircumferential...

Gottumukkala Raju

EMR of large flat lesions is possible, however is technically challenging and time consuming. It can be done safely by endoscopists with experience in the endoscopic mucosal resection technique and endoscopic...

views: 923 comments: 0

IC valve - Large Flat Lesion - EMR - Bleeding

Gottumukkala Raju

EMR of large flat lesions is possible, though, It is technically challenging and time consuming. Also, a large lesions are more likely to bleed after resection, therefore the procedure should be done...

views: 650 comments: 0