the Procedure for Colonoscopy: Key Points and Differences

Q: the Procedure for Colonoscopy: Key Points and Differences

Hello： The key points of the colonoscopy procedure in gastroenterology are as follows： 1. <br>The examination position is left lateral, with both legs bent as much as possible towards the abdomen; kneeling or lying face down is not acceptable. <br>2. <br>Before the examination, a

Procedure for Colonoscopy in Gastroenterology & Surgery

What are the key points of the procedures for colonoscopy in gastroenterology and surgery? (What are the differences?) What are the key points of the procedure for a gastroenterology colonoscopy?
1.
What is the position for the examination? (I heard from friends that some hospitals require patients to kneel and lie on their stomachs during the examination.
Why is this position used?)
2.
Is anesthesia used, and is it general anesthesia? During the examination, will an injection be given? Can it be given in the buttocks instead of the arm? What is the length of the examination? Is continuous enema required during the procedure?
3.
Do patients need to change out of their clothes?
4.
What are EVIC ENEMA and FLEET ENEMA? How are they performed? Can the prone position (lying flat on the stomach) be used during the enema?
5.
Please provide a detailed explanation of the procedure for a barium enema.
6.
For colon examinations (colonoscopy + barium enema), if a large volume of enema is required in the hospital, can the patient assume a prone position on the bed or lie flat with bent legs?
7.
What is a "double contrast enema"? (What position is used?)
8.
Under what circumstances is a colonoscopy performed in a prone position? What should the patient do?

Cheng Ting, 30~39 year old female. Ask Date: 2002/09/03

Dr. Yang Peizhen reply Gastroenterology and Hepatology

Hello: The key points of the colonoscopy procedure in gastroenterology are as follows: 1.
The examination position is left lateral, with both legs bent as much as possible towards the abdomen; kneeling or lying face down is not acceptable.
2.
Before the examination, a shot of an antispasmodic medication must be administered (either in the arm or buttock).
If the patient is particularly anxious about pain, an additional strong analgesic (such as Demerol) may be given.
The length of the examination can vary by individual; the colon, when straightened, may measure less than one meter, but since the colon has only two fixed bends (under the right rib at the liver and under the left rib at the spleen), other sections are free-floating in the abdominal cavity.
Sometimes, due to excessive curvature of the colon, even if the entire colonoscope (which is 160 cm long) is inserted, it may still not reach the most proximal part of the colon.
Therefore, during the examination, the physician must repeatedly maneuver the scope forward and backward to straighten the colon in order to complete the examination.
3.
Prior to the examination, patients should remove their outer and inner clothing and change into specially designed examination pants (similar to those worn by children with a split bottom) to avoid soiling themselves and to facilitate the insertion and removal of the scope.
4.
The most crucial aspect of a colonoscopy is the preparation prior to the examination.
If the patient is at home, they should take two doses of laxatives (Dulcolax) the night before the examination and consume 30 mL of castor oil during the day before the examination, while also drinking at least 2000 mL of water daily to help clear all fecal matter.
For hospitalized patients, in addition to the aforementioned methods, enemas may be used to further cleanse the colon and rectum.
There are many types of enemas, and the solutions used vary; the most common is a single glycerin enema, while a stronger option is a soap suds enema (S-S enema).
Sometimes, for a more thorough cleansing of the colon, a continuous cleansing enema may be used, repeatedly administering the cleansing solution until the expelled fluid is free of feces.
Due to the potential irritation and damage to the rectal or colonic mucosa from the cleansing solutions, cleansing enemas should only be used when absolutely necessary.
A Fleet enema is also a single enema, using a saline soap solution.
As for the Evic enema, we cannot provide information as we have not used this term, and it is not found in medical textbooks.
After an enema, patients need to contract their anal sphincter to allow the cleansing solution sufficient time to stimulate the bowel, so they are usually kept in a left lateral position during the enema for easier contraction.
5.
Typically, a colonoscopy is performed while the patient is awake, allowing the examiner to understand and address any discomfort the patient may experience.
However, some patients may be unable to tolerate the pain, making it impossible to complete the examination.
In such cases, anesthesia may be considered, using intravenous administration of an appropriate dose of a short-acting muscle relaxant or sedative to induce sleep.
The advantage is that the patient does not feel pain, but the disadvantage is that patients with pre-existing cardiopulmonary conditions (especially the elderly) may experience respiratory depression leading to hypoxia, which poses a life-threatening risk.
Therefore, vital signs and blood oxygen levels must be continuously monitored throughout the procedure, and immediate resuscitation must be provided if any abnormalities arise.
After the examination, the patient must be observed until they regain consciousness before being allowed to go home.

Reply Date: 2002/09/03

More Info

Colonoscopy is a crucial procedure in gastroenterology and surgery, primarily used for examining the large intestine (colon) for abnormalities such as polyps, inflammation, or cancer. Understanding the procedure, its preparation, and the differences between gastroenterology and surgical approaches is essential for patients considering this examination.

Key Points of Colonoscopy Procedure
1. Positioning:
- The standard position for a colonoscopy is the left lateral position (lying on the left side with knees drawn towards the chest). This position facilitates easier access to the colon and minimizes discomfort. Some facilities may use a prone position (lying face down), but this is less common and typically not recommended for routine colonoscopy.

2. Anesthesia:
- Colonoscopy can be performed under sedation or general anesthesia. In gastroenterology, moderate sedation is often used, allowing the patient to remain conscious but relaxed. In surgical settings, general anesthesia may be employed, especially if the procedure is expected to be more invasive or if the patient has a higher anxiety level.

3. Preparation:
- Prior to the procedure, patients must undergo bowel preparation, which typically involves a clear liquid diet and the use of laxatives (like Fleet or other cleansing solutions) to ensure the colon is clear of stool. This preparation is crucial for the accuracy of the examination.

4. Enema Types:
- Fleet Enema: This is a saline solution used to stimulate bowel movements and is often used as part of the preparation process.

- Evic Enema: This term is less commonly recognized in standard medical literature and may refer to a specific type of enema used in certain protocols. It’s best to clarify this with the healthcare provider.

5. Clothing:
- Patients are usually required to change into a hospital gown to facilitate the procedure and maintain hygiene.

6. Colonoscopy vs. X-ray:
- A colonoscopy allows for direct visualization and intervention (like polyp removal), while a colon X-ray (like a barium enema) provides imaging but does not allow for therapeutic procedures.
7. Post-Procedure Care:
- After the procedure, patients are monitored until the effects of sedation wear off. They are advised not to drive or operate heavy machinery for at least 24 hours post-sedation.

Differences Between Gastroenterology and Surgical Approaches
- Gastroenterology: Focuses on the diagnosis and treatment of gastrointestinal disorders. The colonoscopy performed by gastroenterologists is typically less invasive, with an emphasis on outpatient care and minimal sedation.

- Surgical Approach: Surgeons may perform colonoscopies in more complex cases, such as when there is a known history of adhesions or other surgical complications. They may also be more likely to use general anesthesia and may have a higher threshold for converting to surgical intervention if complications arise during the procedure.

Risks and Considerations
- Perforation Risk: Patients with a history of abdominal surgeries or adhesions may have a higher risk of perforation during colonoscopy. This risk necessitates careful evaluation and possibly alternative imaging methods like CT or MRI if the risk is deemed too high.

- Follow-Up: If the colonoscopy does not reach the cecum (the beginning of the large intestine), a repeat procedure may be necessary. This is particularly important if there are findings that require further investigation.

Conclusion
Colonoscopy is a vital tool in the early detection and prevention of colorectal diseases. Understanding the procedure, its preparation, and the differences in approaches can help alleviate patient anxiety and ensure a smoother experience. Patients should always discuss their specific concerns and medical history with their healthcare provider to tailor the procedure to their needs.

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