Colonoscopy

Colonoscopy enables your doctor to examine the lining of your colon (large intestine) for abnormalities by inserting a flexible tube as thick as your finger into your anus and slowly advancing it into the rectum and colon. You are sedated and the procedure is pain free.

Common indications: screening (to look and remove polyps which are precursors for cancer), abdominal pain, diarrhea, bleeding, anemia, weight loss.

Insert: Understanding Colonoscopy Video

Will these procedures be covered by my insurance company?

We always check with your insurance and obtain an authorization if required before the procedure. Insurance companies generally cover most of the the cost. Most policies have a deductable and a co-pay and your part of the costs depend on your coverage. Generally, the deductible is 20%. Many policies cover Screening Colonoscopies at 100% with no deductable. If a polyp is removed during the procedure you might have to pay a part of the costs.

How is the bowel prepared for Colonoscopy?

We generally perform colonoscopy using 2 liter of Prep (Half Lytely) compared to the traditional 4 liters of Golytely. However, these preps are slightly more expensive and not covered by Medicare. A lot of our patients choose Golytely and end up drinking only 2-3 liter instead of the whole 4 liter. We also offer Preps with smaller quantity called OSP - Oral Sodium Phosphate, but they tend to cause metabolic disturbances leading to kidney injury (phosphate nephropathy). One other option that is commonly used is a Magnesium Citrate Prep with Ducolax. These Preps carry FDA labelled black box warning.

If the procedure is scheduled for the afternoon, the prep is taken early on the morning of the procedure or could be a split dose - half the night before the procedure and other half in the morning of the procedure. Our experience has shown this is well tolerated with little risk of fecal incontinence on the way to the Endoscopy center. Morning procedures usually require the prep be taken the day before the procedure.

You can choose your own Prep after consulting Drs. Subramanyam or Malhotra. Please let us know if you prefer any special Prep.

How much time does it take at the Endoscopy Center?

A total of 2-3 hours. We ask our patients to check in at the Bay Area Houston Endoscopy Center 1 hour before the scheduled time. During this period, a nurse would ask you questions regarding your health, place an IV line and dress you in a gown for the procedure. Average time for single procedure (EGD or colonoscopy) is 15-30 minutes, and when doing both of the procedures it can take up to 30-45 minutes. The patient spends about 30 minutes in recover. Soon after the procedures Drs. Subramanyam and Malhotra would briefly talk to the family regarding the findings of the procedure. Please do not consider this to be a substitute for the follow up appointment in the office that you need to keep for getting the biopsy results and further management.

What type of sedation is used for the endoscopic procedures?

We generally use TIVA (Total intravenous anesthesia - intravenous drugs Versed, Fentanyl, Propofol) to sedate patients that do not require airway intubation (placement of a breathing tube). In most cases, a Nurse anesthetist administers the drugs and monitors the patient closely during the procedure. The patient breathes on his own but is sedated enough not to have any discomfort, pain or recollection of the procedure.

In some cases MCS (Moderate Conscious Sedation - Fentanyl, Versed but no Propofol) is used that leads to a lesser degree of sedation but again the patient generally dol not experience pain or discomfort during the procedure.

With both forms of sedation, patients generally cannot recall what is said after the procedure and hence it is important for a family member to be present so that the doctor can explain the result of the procedure after it is completed.

Can I take my medications before the procedure?

Yes, its okay to take your medications with sip of water at least 1 hour before the start of the procedure.

What if the colonoscopy shows something abnormal?

If your doctor thinks an area needs further evaluation, he or she might pass an instrument through the colonoscope to obtain a biopsy (a sample of the colon lining) to be analyzed. Biopsies are used to identify many conditions, and your doctor might order one even if he or she doesn't suspect cancer. If colonoscopy is being performed to identify sites of bleeding, your doctor might control the bleeding through the colonoscope by injecting medications or by coagulation (sealing off bleeding vessels with heat treatment). Your doctor might also find polyps during colonoscopy, and he or she will most likely remove them during the examination. These procedures don't usually cause any pain.

What are polyps and why are they removed?

Polyps are abnormal growths in the colon lining that are usually benign (noncancerous). They vary in size from a tiny dot to several inches. Your doctor can't always tell a benign polyp from a malignant (cancerous) polyp by its outer appearance, so he or she might send removed polyps for analysis. Because cancer begins in polyps, removing them is an important means of preventing colorectal cancer.

How are polyps removed?

Your doctor might destroy tiny polyps by fulguration (burning) or by removing them with wire loops called snares or with biopsy instruments. Your doctor might use a technique called "snare polypectomy" to remove larger polyps. That technique involves passing a wire loop through the colonoscope and removing the polyp from the intestinal wall using an electrical current. You should feel no pain during the polypectomy.

What are the possible complications of colonoscopy?

Colonoscopy and polypectomy are generally safe when performed by doctors who have been specially trained and are experienced in these procedures.

One possible complication is a perforation, or tear, through the bowel wall that could require surgery. Bleeding might occur at the site of biopsy or polypectomy, but it's usually minor. Bleeding can stop on its own or be controlled through the colonoscope; it rarely requires follow-up treatment. Some patients might have a reaction to the sedatives or complications from heart or lung disease.

Although complications after colonoscopy are uncommon, it's important to recognize early signs of possible complications. Contact your doctor if you notice severe abdominal pain, fever and chills, or rectal bleeding of more than one-half cup. Note that bleeding can occur several days after the procedure.

How often does one need a Colonoscopy?

It is recommended that all asymtomatic patients with normal laboratory studies over 50 years undergo a Screening Colonoscopy. If no polyps are found then follow up exam at 5-10 year interval is recommended. If polyps are found, a more frequent schedule may be necessary depending on the size, nature (stalk or no stalk) and histology (pathology) of the polyp.

In symptomatic patients (rectal bleeding, abdominal pain, change in bowel habits etc) or in those with abnormal labs (anemia), EGD and/or Colonoscopy is indicated regardless of age or when the last endoscopic exam was performed as these patients are likely to have lesions discovered at the exam.

We are providing general guidelines for follow up exam. Please understand that these are guidelines only and the interval may have to be tailored according to the findings.

Guidelines for Colonoscopy Intervals:

1. No Polyps in the past and during first colonoscopy: 5-10 years. Scientific literature reports a waiting time of 10 years. However, we have realized that it is also determined by the quality of the prep and the percentage of missed polyp that could be as high as 5-10% during colonoscopy. By taking in to consideration these two factors, we suggest 5 years although waiting 10 years could be acceptable in many cases.
2. Personal history of polyps : 3-5 years.
3. Flat, large polyp or abnormal findings at pathology : 6 month -1 year.
4. Family history of colon cancer in first degree relative : 3 yearly