Flexible Sigmoidoscopy

Overview: The Basics

A sigmoidoscopy is an internal exam of the lower part of the large colon using a short, thin, flexible lighted tube ("scope"). It is inserted into the rectum and slowly guided into the colon. The tube, called a flexible sigmoidoscope, has a lens for viewing. It may also have a small biopsy instrument to remove tissue to be checked under a microscope for signs of disease.

What to Expect: During the Screening

During the test the patient is positioned on the left side with knees drawn up toward the chest. First, the doctor will do a digital rectal exam by gently inserting a gloved and lubricated finger into the rectum to check for any abnormalities.

Next, the sigmoidoscope is inserted into the rectum, and the patient will feel some pressure. Air is gently introduced through the scope to expand the colon and help the doctor see well. The doctor then moves the scope as far as needed to examine the lower colon. As the scope is slowly removed, the lining of the bowel is carefully examined. A hollow channel in the center of the scope allows for the passage of forceps for taking a biopsy if needed.

What can be found?

The doctor can help the patient determine the cause of abnormal results and diagnose the cause of diarrhea, bowel obstruction, diverticulosis, inflammatory bowel disease, anal fissures, hemorrhoids as well as find colon polyps that might be in this lower part of the colon.

How to Prepare

The colon and rectum must be completely empty for flexible sigmoidoscopy to be thorough and safe. Some doctors recommend a combination of a laxative and a small enema before the test. Some doctors may advise the patient to drink only clear liquids for 12-24 hours before the procedure is scheduled. A liquid diet means clear, fat-free bouillon or broth, gelatin, strained fruit juice (no grape juice or any liquid with red color), water, plain and unsweetened coffee or tea, or diet soda. The night before, or even immediately before the flexible sigmoidoscopy, the patient may be given an enema, which is a liquid solution that washes out the lower intestine.


Colonoscopy

Overview: The Basics

A colonoscopy is a visual examination of the entire large intestine (colon) using a lighted, flexible colonoscope. To be certain you are comfortable and relaxed, you will be sedated through an I.V. In fact, most patients are asleep during the entire process and remember little to nothing about it.

What to Expect: During the Screening

When it's time to start the screening, you will be asked to lie on your side. Once sedation takes effect, the colonoscope is inserted through the rectum and moved gently around the bends of the colon. As the colonoscope makes its way through the colon, the physician can see the lining of the colon on a television screen. Typically, the physician looks all the way to the end of the large intestine, and back, for anything unusual. The entire scoping process typically takes between 15 and 30 minutes. When complete, your nurse will take you into a recovery area, where the sedation quickly wears off. Your physician will talk to you about your test and any findings.

What can be found?

If polyps (very small growths of tissue) are found, your doctor can perform a biopsy immediately. The biopsy involves passing an instrument through the scope to remove the polyp, which is sent to a laboratory to be analyzed.

You should feel nothing when a biopsy or polyp is taken, and you should experience no recovery pain. While the overwhelming majority of polyps are harmless, your physician will have it tested and confirm your results with you, usually within 24-72 hours depending on the day of the week of the procedure. Furthermore, since most colon cancer starts as a benign polyp, when these are removed, the possibility of them growing into cancer is removed as well.

What happens afterwards?

Once your recovery nurse determines that most of the effect of the sedation has worn off, you will be released, however, you cannot drive. Even though you will feel fine, the lingering, subtle effects of the sedation will make it dangerous for you to drive, so a responsible adult must be there to take you home. You should be able to resume normal activity the next day.

How to Prepare

Thorough cleansing of the entire bowel is essential for effective results so there will not be a need for retesting. Instructions for doing this will be given by your physician, but this can include a combination of the following: enema, restriction from eating solid foods a day or two before the test and taking pill-form and/or liquid laxatives. You may be told to stop taking aspirin or other blood-thinning medications for several days before the test as well.

To avoid dehydration, patients should drink clear, fat-free bouillon or broth, gelatin, strained fruit juice (no grape juice or any liquid with red color), water, plain and unsweetened coffee or tea, or diet soda. Unless otherwise instructed, continue taking any regularly-prescribed medication. Your physician may also ask you to stop taking iron preparations a few weeks before the test if you are on them. Finally, you need to arrange for someone to drive you home afterward because lingering, subtle effects of the sedation will make it unsafe for you to drive until the next day.

Your doctor will also want to know if you have heart disease, lung disease, or any medical condition that may need special attention.


Upper Endoscopy

Overview: The Basics

Also called an EGD or gastroscopy, an upper endoscopy uses a thin scope with a light and camera at its tip, called an endoscope, to look inside the upper digestive system of the esophagus, stomach and the first part of the small intestine. The endoscope is passed through the mouth and down the throat to the esophagus. It may also have a small biopsy instrument to remove tissue that is then checked under a microscope for abnormalities.

What to Expect: During the Screening

You will be given a sedative, and a local anesthetic may be sprayed into your mouth to suppress the gag reflex when the endoscope is inserted. A mouth guard will be inserted to protect your teeth as well as the endoscope. Dentures must be removed.

In most cases, an intravenous line will be inserted into the arm to administer the sedation and any medications that might be needed. You will lie on your left side, and, after the sedative has taken effect, the endoscope will be gently guided through the esophagus to the stomach and the beginning of the small intestine. Air will be introduced through the endoscope to enhance viewing. The lining of the esophagus, stomach and upper small intestine is examined, and biopsies can be performed at the same time.

After the test is complete, food and liquids will be restricted to prevent choking until the anesthetic wears off and the gag reflex returns.

The actual test lasts about 10 to 20 minutes. There may be a sensation of gas after the procedure. Biopsies cannot be felt. Because of the intravenous sedation, you likely will not feel any discomfort and may have no memory of the test.

What can be found?

An upper endoscopy can help determine causes for heartburn, the presence of hiatal hernias, the cause of abdominal pain, unexplained anemia, and the cause of swallowing difficulties, upper GI bleeding, and the presence of tumors or ulcers.

How to Prepare

The stomach must be empty for the procedure to be thorough and safe, so you must fast about 6-12 hours before the test. You may also be told to stop aspirin and other blood-thinning medications for several days before the test. You should also arrange for someone to take you home because of the sedation during the procedure. Your physician may give other special instructions.


Colon Cancer Screening

Have you been told that you should be screened for colon cancer but have been avoiding it? There are a few things that you should know.

  1. Colon cancer is one of the most common cancers in the United States in men and women. This usually starts as a small growth called a polyp, which over time can turn into cancer.
  2. Colon cancer is also one of the most curable forms of cancer. This is accomplished by undergoing a colon exam and removing any polyps that might be found.
  3. It is recommended that everyone after age 50 should undergo colon cancer screening. However, if there is a family history of colon cancer then the screening should be done earlier.
  4. There are several ways to examine the colon: Colonoscopy, Sigmoidoscopy, Barium Enema, CT Colonography.
    1. Colonoscopy consists of using a lighted, flexible tube to examine the entire colon while receiving sedation.
    2. Colonoscopy is the only procedure, which can remove polyps.
    3. Sigmoidoscopy examines only the lower part of the colon.
    4. Barium Enema is a series of x-rays of the colon.
    5. CT colonography is a newer test, which uses a CT scanner to assemble pictures of the colon.
    6. Your doctor can help you decide which screening method is best for you.
  5. For additional information, see the following links.
    1. Who should be screened? http://www.gastro.org/wmspage.cfm?parm1=685
    2. Screening Tests. http://www.cancer.gov/cancertopics/pdq/screening/colorectal/Patient/page3
    3. Questions & Answers. http://www.cancer.gov/cancertopics/factsheet/Detection/colorectal-screening
    4. Colon Cancer. http://www.cancer.gov/cancertopics/pdq/screening/colorectal/Patient/page2