Major indications for colonoscopy include:
- Screening for colon cancer
- Evaluation of lower gastrointestinal bleeding
- Evaluation of unusual gastrointestinal symptoms such as persistent diarrhea or constipation
- Further workup of an abnormal imaging studies such as CT or x-ray
- Further evaluation of the patient prior to having a colon resection
- Further localization of a polyp or tumor prior to surgery
- The evaluation of patients with chronic colitis or inflammatory bowel disease
- To evaluate the small intestine in patient suspected of having Crohn’s disease
- To evaluate unusual symptoms that may be related to colon stricture, obstruction or bleeding from colon tumors
The American Society of Gastrointestinal Endoscopy suggests to schedule a colonoscopy procedure when:
Patient’s health requires a change of their nutritional program
Patient is treating disease or preventative care for disease
A therapeutic intervention may be needed: such as removing a colon polyp, lesion or when taking samples of the colon
Who Should Come to Our Clinic
Colonoscopy is recommended as the best way to prevent colon cancer. “Average risk” patients are recommended having a screening colonoscopy at age 50. African Americans may have a slightly higher risk of colon cancer, and colonoscopy can be recommended at age 45.
For More Information Regarding Colonoscopy See our FAQ Section Below
Frequently Asked Questions about
a Colonoscopy Procedure
Answered by Dr. William Lyday at Gastroenterology Atlanta
Colonoscopy is a non-surgical procedure that uses a lighted scope to examine the lining of the colon. The colon “scope” is essentially a long tube that uses fiber optic technology to provide very detailed images in real time. During the procedure, the patient is sedated and the scope is inserted into the rectum and advanced carefully until all areas of the colon are examined.
If you need to schedule a colonoscopy there are a few options:
- Call our office and speak directly to the medical assistant (404-257-0000).
- Or fill out our online form (above) to schedule an appointment and send in your request.
If you are in good health you may be eligible to go directly to scheduling your procedure without the doctor visit. Direct scheduling is for individuals who are otherwise healthy and are not experiencing any severe physical symptoms.
You can discuss direct scheduling with our team and see if this is a good option for you.
Colonoscopy is recommended as one of the best ways to detect and prevent colon cancer. Patients who are at “average risk” are usually recommended a colonoscopy at age 50. African Americans may have a slightly higher risk of colon cancer when compared to other populations, and colonoscopy can be recommended at age 45 years.
There are several factors which raise the risk of colon cancer:
- Family history of colon cancer
- Family history of colon polyps
- Personal history of inflammatory bowel disease ( Crohn’s and ulcerative colitis)
- Personal history of a genetic syndrome associated with colon cancer
- Receiving abdominal radiation as a child
- HIV infection
Globally, the incidence of colon cancer varies over 10-fold. The highest incidence rates are in Australia, New Zealand, Europe, and North America, and the lowest rates are found in Africa and South-Central Asia. We think these differences are due to differences in diet and environment, but also underlying genetic factors.
In the United States, the lifetime incidence of colon cancer in patients at average risk has been estimated to be approximately 4 percent. Colon cancer rates are also around 25 percent higher in men than in women.
There is a tremendous amount of interest in finding alternatives to colonoscopy. Alternatives include: testing stool DNA for mutations, CT scan of the abdomen with contrast, Barium enema and others. Unfortunately none of these technologies are anywhere near as effective in detecting and removing pre-cancerous polyps (growths) within the colon. It is important to remember that the only way to reduce colon cancer is by removing these pre-cancerous growths and only colonoscopy does that.
CT, Barium enema, MRI , Stool DNA testing are much better for detecting cancers that have already developed and are more advanced.
A physician who has done several years of additional training and specializes in performing colonoscopy is called a Gastroenterologist. A Gastroenterologist is not a surgeon and they are experts in digestive diseases, colon cancer screening and performing non-surgical procedures to identify problems within the gastrointestinal tract and liver.
As the name suggests colonoscopy only examines the colon. Other names for colon includes: lower intestine or large intestines. Usually, a very small amount of the small intestine is also seen where it connects with the colon. This region is called the terminal ileum.
The colonoscopy is not able to see the esophagus, stomach, liver, pancreas, uterus, kidneys or other organs outside the colon.
The colon is broken down into several regions. When performing a colonoscopy, the scope begins in the rectum and is advanced carefully into the rectosigmoid, sigmoid, descending, transverse, ascending colon and finally the cecum. When the scope has reached the cecum, the entire colon has been examined.
We use these names to help us record where abnormalities have been found during the procedure. For example, if a colon polyp or cancer is found, rather than saying the abnormality was found in the colon – we specify which part of the colon – especially when there is a possibility that surgery will be needed to remove the abnormality.
- Colon Polyps
- Inflammation – Colitis, Crohn’s disease, ulcerative colitis
- Less likely :
- Colon cancer
- Ischemia – low blood flow with injury
- Strictures and narrowing
- Metastatic tumors invading the colon
Colon polyps can be cancerous, precancerous or have no cancerous potential at all.
Characterization of colon polyps is performed by the pathologist – a laboratory physician who specializes in identifying microscopic abnormalities within tissue specimens. Following a polyp removal, the sample is sent to the laboratory and specimens cut into tiny fragments. Often, special stains are applied to the polyp sample to help magnify the cellular architecture. After examining the polyp using a high powered microscope, the pathologist will report their findings. Common types of colon polyps include:
- Tubular adenoma, tubulovillous adenoma, serrated adenoma
- These are all considered precancerous and should be removed to prevent progression to cancer
- Hyperplastic polyps – very little potential for ever becoming cancerous
There are several factors which determine how often colonoscopy should be performed. This is best discussed with your gastroenterologist after the procedure and the polyp has been fully analyzed by the pathologist.
Factors associated with higher cancer risk family history, polyp size, presence of dysplasia within the polyp and if there is any concern that the entire polyp was not removed.
Fortunately, patients are given sedation by an anesthesia team and this has virtually eliminated the element of pain or discomfort during colonoscopy. The most common sedation medication used is called Propofol which appears to be very safe and effective. The patient is typically asleep for the entire procedure and monitored closely for adequate respiration, pulse, and blood pressure.
Colonoscopy can be performed in a variety of settings such as…an outpatient procedure center, a hospital, and occasionally in a medical office. Any center that performs colonoscopy must be approved by state and local governing bodies, and must have well trained staff and appropriate equipment.
We use several centers:
Different centers will vary in their recommendations, but we recommend the following:
1. 1 week before the procedure:
- Be sure that you have reviewed all of your medications, health problems, or other concerns with the doctor who is performing your colonoscopy.
- In general, patients should off blood thinners, anticoagulants, iron supplements, or any of the NSAIDs – such as Aspirin, Advil , Aleve etc.
- However, Be sure that you have your doctor’s approval before stopping any medications.
2. Two days before the colonoscopy:
- Begin a low fiber diet – avoid raw fruits and vegetables.
- If you tend to have constipation, we also recommend you begin Miralax three –four times per day.
- Make sure you have purchased your colonoscopy prep and reviewed all instructions on getting ready for the procedure.
- Stock your refrigerator with all the liquid drinks you will be allowed to have the following day.
3. One day before the colonoscopy:
- Mix your colon prep and place in the refrigerator so it is being chilled during the day.
- Begin a liquid diet – clear soups, broths, Jello, Gatorade … these are all fine. We also allow a low fiber breakfast – scrambled eggs, yogurt, smoothies, protein drinks – but they should be lactose free.
- Many patients find that taking an antacid such as OTC Prilosec is helpful in calming the stomach.
- 1 PM – go to clear liquids only – no more protein shakes or smoothies.
- Anytime after 1 PM is fine for taking your colon prep.
- The colon prep is contained within a gallon jug. We recommend drinking an 8 oz glass of the solution every 15 minutes until finished.
- After midnight, no eating or drinking.
4. What if I Have Problems drinking the colon prep?
- It is not uncommon to hear a patient complain of abdominal pain, cramping, bloating, and nausea. After all, it is a large amount of liquid – 1 gallon!!! If symptoms seem too severe, we recommend you stop drinking the prep and notify the medical office. Common suggestions include taking a break for a few hours and trying again more slowly. There are also several medications that can be prescribed by the medical team to help reduce nausea and improve the experience, just let us know.
5. Day of the Procedure
- Be sure you have correct directions and time of procedure. Most centers require that you arrive at least 1.5 hours before the exam.
- You must have a driver who can wait at the center with you and take you home.
6. After the Procedure
- Immediately following the colonoscopy, the doctor and medical staff will give a brief report on the findings. After a period of time, if feeling well , you will be discharged home with your driver.
- If you are having any pain, discomfort, fever, chills, abdominal tenderness, or other severe symptoms, you will need to call the doctor immediately at 404-257-0000.
- It is not unusual to experience some mild cramping, bloating and this is to be expected.
- Go slow with food – start with liquids and soft foods. If feeling well, your diet can return to normal later in the day.