Colonoscopy Procedures

What is a colonoscopy?
Colonoscopy is a procedure, which enables the direct visualization of the lining of your colon (large intestine). A flexible tube, as thick as your finger, is inserted into the anus and slowly advanced from the rectum to the cecum (the anatomic beginning of the colon). Lesions such as polyps, colon cancer and inflammation can be found during a colonoscopy. Biopsies can be obtained, and most polyps can be removed during a colonoscopy.

Can I eat the day before?
Most patients can enjoy a regular diet until 6:00 PM the day prior to their colonoscopy.  This may differ from what you have done prior to a previous colonoscopy.  The latest data shows us that a regular diet can be maintained until 6:00 PM the day before your procedure.  If you would like to take only clear liquids the day before the procedure, this will not interfere with your prep.  Sometimes your physician may ask you to alter your diet prior to colonoscopy preparation, but if this is needed, your doctor will discuss this with you at your office visit.

What preparation is required?
A laxative preparation is taken the night before and again, approximately 5 hours, prior to the procedure. Recent research has shown that “split dosing” leads to a better visualization of the colon. The colon must be completely clean for the procedure to be accurate and complete, so it is important to follow the instructions carefully. More specific instructions will be given to you when you schedule a colonoscopy. Please refer to our Pre-Procedure Instructions section in our website and our One & Done pamphlet for more details.

Can I take my current medications?
Most medications can be continued as usual, but some medications can interfere with the preparation or the examination. Inform us about medications you’re taking, particularly aspirin products, arthritis medications, anticoagulants (blood thinners), insulin or iron products.

What about Aspirin?
Do not stop aspirin.  You may have stopped aspirin before a previous colonoscopy. The latest research and guidelines tell us that it is safe to perform routine colonoscopy and polyp removal while patients continue their aspirin.  The data also shows us that the risk of bleeding is very low and when compared with the risk of a stroke or other clotting event, bleeding is relatively easy to control.  Major clotting events, such as stroke can leave irreversible damage.

What about Plavix® (clopidogrel)?
Do not stop Plavix® (clopidogrel). You may have stopped Plavix® (clopidogrel) before a previous colonoscopy. The latest research and guidelines tell us that it is safe to perform routine colonoscopy and polyp removal while patients continue their Plavix® (clopidogrel).   The data also shows us that the risk of bleeding is very low and when compared with the risk of a stroke or other clotting event, bleeding is relatively easy to control.  Major clotting events, such as stroke can leave irreversible damage.

What about Coumadin®?
Do not stop Coumadin®.  You may have stopped Coumadin® before a previous colonoscopy. The latest research and guidelines tell us that it is safe to perform routine colonoscopy and polyp removal while patients continue their Coumadin® as long as there INR is in the routine therapeutic range of between 2 and 3. The data also shows us that the risk of bleeding is very low and when compared with the risk of a stroke or other clotting event, bleeding is relatively easy to control.  Major clotting events, such as stroke can leave irreversible damage.

What about anti-inflammatory medicine, like Motrin®, Aleve®, ibuprofen, Naprosyn®, or naproxen?
Depending on the specifics of your procedure, it may be okay to continue taking these medicines.  Check with your doctor for more information.

What if I take diabetes medicine?
If you have diabetes and have an appointment before noon, do not take your diabetes medicine on the morning of your test.

If you have diabetes and have an afternoon appointment, take half of your diabetes medicine on the morning of your test.

You will resume these medicines after the test.

What if I take blood pressure medicine?
If you take blood pressure medicine, be sure to continue using the medicine while preparing for the test. On the day of your test, you should take your blood pressure medicine with a sip of water at least 2 hours before your test.

Will I need antibiotics?
No. Even if you have a prosthetic heart valve or other prosthesis, the latest recommendations by the Gastrointestinal and Cardiovascular societies do not recommend the use of antibiotics for routine colonoscopy regardless of prosthetic devices.

What happens during colonoscopy?
Colonoscopy is well tolerated and pain-free. You will be given a sedative, propofol, by our anesthesia team who will be present to monitor your vital signs during the examination.

You will lie on your side or back during the procedure. The endoscope is a thin flexible tube that has a light and a camera at the tip. Images from the camera transmit to a TV monitor in the procedure room, allowing the doctor to see the inside of your colon on a screen. The doctor will then look for polyps, cancer, or other abnormalities throughout your colon. Your doctor will also remove any polyps that are found.

The doctor will begin the colonoscopy by examining your rectum to make sure you do not have stool left in your bowels. The doctor will then inflate your colon with a soft stream of air. This will help the doctor get a clear look in your colon. The doctor will then advance the endoscope through your colon.

The procedure itself usually lasts approximately 10-30 minutes, although you should plan on one to two hours for preparation and recovery.

In some cases, the colonoscopy may not be completed due to a variation in the person’s colon anatomy and concern for a higher risk of a perforation. In this case, we may recommend a CT colonography (virtual colonoscopy) or a barium enema to visualize the portions of the colon which were not visualized during the colonoscopy.

What if the colonoscopy shows something abnormal?
If an area needs further evaluation, a biopsy may be obtained. If polyps are found during a colonoscopy, they will most likely be removed during the examination.

What are polyps and why are they removed?
Polyps are abnormal growths in the colon lining that are usually benign (non-cancerous). They vary in size from a tiny dot to several inches. Because cancer begins in polyps, removing them is an important means of preventing colorectal cancer.

How are polyps removed?
Tiny polyps are removed with wire loops called snares or with biopsy instruments. A technique called “snare polypectomy” is used to remove larger polyps. This 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 happens after a colonoscopy?
The results of the examination will be discussed with you. If a biopsy was taken or a polyp was removed, the material is sent to a pathology lab and the results are available in approximately 5 business days. Your results will be given to you directly at a follow-up appointment or you will receive a letter via standard mail delivery with the results and recommendations for follow-up.  All of the results, including your pathology results and procedure reports will be forwarded to your primary care physician and the physician that referred you to Gastroenterology Consultants.

You will not be allowed to drive for 12 hours. You will need to arrange for someone to escort you home from our office. Even if you feel alert after the procedure, your judgment and reflexes could be impaired for the rest of the day. You might have some cramping or bloating because of air that is introduced into the colon during the examination. This should disappear quickly when you pass gas.  Walking is the best way to pass the excess gas quickly.

When can I eat after the colonoscopy?
You should be able to eat normally after the examination.

What are the possible complications of colonoscopy?
Complications are uncommon but may include a perforation, or tear, through the bowel wall that could require surgery. Bleeding might occur at the site of biopsy or polypectomy, but is 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 sedative agent.

Although complications after colonoscopy are uncommon, it’s important to recognize early signs of possible complications. Contact us immediately 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.