Diagnostic and Screening Colonoscopy
What is a colonoscopy?
A colonoscopy is a safe, effective method of using a tubular instrument with a camera to examine the full lining of the colon and rectum in order to detect any changes or abnormalities. Colonoscopies are used to diagnose large intestine or rectal problems, as well as screen for polyps or cancer, and most can be done with minimal discomfort via outpatient services. Though the procedure is the same, there are two types of colonoscopies: diagnostic and screening.
Diagnostic colonoscopy is used to help diagnose abdominal or bowel conditions that might be causing symptoms such as pain, diarrhea, or bloody stool. Most insurance companies and Medicare do not waive the copay or deductible for a diagnostic colonoscopy.
Screening colonoscopy, on the other hand, is used to test for the presence of colorectal cancer or polyps in asymptomatic individuals and is part of regular preventative care designed to catch the disease as early as possible to improve the chance of cure. Notably, the Affordable Care Act (ACA) requires Medicare and most insurance companies to cover preventative services like screening colonoscopies without a copay or deductible.
Who should have a Diagnostic Colonoscopy?
If you have abdominal, intestinal, or rectal symptoms that could indicate a more serious problem, your physician may recommend a diagnostic colonoscopy exam. Symptoms and signs that might require a diagnostic colonoscopy are:
- Abdominal issues such as pain, cramping, or burning.
- Intestinal symptoms like rectal bleeding, inflammatory bowel disease (colitis), or excessive mucus.
- Changes in bowel habits such as chronic constipation or diarrhea.
- Unexplained weight loss.
Who should have a Screening Colonoscopy?
Doctors routinely recommend a screening colonoscopy every ten years for adults 50 years of age and up, in order to test for colorectal cancer and provide preventative care.
For people with a family history of colon cancer, a personal history of inflammatory bowel disease, or other risk factors, your doctor may recommend earlier screening.
African Americans benefit from screening beginning at age 45.
How should a patient prepare for a colonoscopy?
One to two days before a colonoscopy exam, the patient’s bowel must be thoroughly cleared of all residue using a preparation prescribed by the physician. This will remove any obstructions and enable the doctor to more accurately examine the bowel. . In order to empty the colon, patient usually need to:
- Follow the instructions for the bowel preparation
- Follow a special diet the day before the exam, including eliminating solid foods and limiting beverages to clear liquids.
- Adjust medications and supplements, particular those containing iron or that are related to blood pressure, anticoagulation, heart problems, or diabetes.
How is a colonoscopy performed?
A colonoscopy procedure is performed using a long, flexible, narrow tubular instrument with a light and a tiny camera (called a colonoscope or scope) to look inside the rectum and colon for irritated or swollen tissue, ulcers, or polyps growing on the intestinal lining. The scope inflates the large intestine with air to improve visibility, and the camera sends images to a screen where the doctor can more carefully examine the intestinal tissues. The doctor will remove any polyps found during the procedure and perform biopsies as needed to conduct further testing.
A colonoscopy usually takes less than 30 minutes and is done at a hospital or outpatient facility. Many patients receive intravenous sedation and pain medication to help them relax during the exam. Following the colonoscopy, patients may experience slight discomfort, bloating, or gas, but most can resume regular activities later that day or the next morning.
What are the risks of colonoscopy?
Colonoscopy is a very safe procedure with complications occurring in less than 1% of patients. Though rare, the most common complications from colonoscopy include bleeding, intestinal perforation or tear, severe abdominal pain, irritation to the colon, and cardiovascular issues like increased heart rate or low blood pressure.
Our Recommendations
We strongly believe based on current screening modalities, that a colonoscopy at least every 10 years represents the most appropriate method for evaluating colorectal health. The latest bowel preparations combined with today’s sedation practices has made the test easier and safer than ever. For most patients, the test lasts less than 20 minutes and is typically offered as an outpatient procedure. Compared with other approaches, colonoscopy is not only the most effective tool at finding small polyps, but provides the only means to biopsy and remove polyps once they are found. This combination has made it the most widely utilized screening test for colorectal cancer and polyps.