Although colonoscopy is the gold standard for examining the colon, many people are still afraid or embarrassed about this procedure. Who needs this study and why?

Our expert – Endoscopist, Associate Professor, Department of Surgery, Institute of Clinical Medicine named after A.I. N. V. Sklifosovsky Sechenov University, Head of the Department of Endoscopy, Clinical Clinical Hospital No. 2, P.M. I. M. Sechenova, Deputy Chairman of the Branch of the Russian Endoscopic Society Candidate of Medical Sciences Pavel Pavlov.

Colonoscopy is not only an examination of the walls of the intestine using a flexible device called a colonoscope. During the procedure, therapeutic interventions can also be performed – from taking a biopsy (pieces of the mucous membrane) to removing large neoplasms from the intestine.

Colon cancer in 80-90% of cases affects people over 60 years of age. Therefore, it is recommended to be examined 10 years earlier, when precancerous pathology most often appears – small benign neoplasms (polyps). The first colonoscopy is best done at 40-45, and then repeated every 5 years. If there were cases of colorectal cancer in the family, it is necessary to be examined 10 years before the age at which the neoplasm was discovered in the relative.

When to do?

The main concern of patients considering colonoscopy is colorectal cancer. It is not yet possible to detect it by non-invasive methods (for example, radiation), since neither X-ray nor CT “see” small tumors of the intestine, and often do not notice large, but flat tumors. Even if the doctor suspects something, the patient will still have to do a colonoscopy to clarify the diagnosis. Colonoscopy allows not only to detect problems in the intestine, but also to get rid of them immediately. If the surgeon finds polyps, he will immediately remove them.

How to decide?

Among the obvious indications for colonoscopy are unmotivated weight loss and a decrease in hemoglobin levels, the appearance of blood in the stool, alternating constipation and diarrhea, or sudden constipation. And also – the “threshold” age, family history, bad habits (smoking is a significant risk factor for colorectal cancer).

About the blood on toilet paper is worth mentioning separately. Its cause can be not only enlarged hemorrhoidal veins, but also diverticula in the large intestine, and ulcerative (as well as other) colitis, and large polyps, and, unfortunately, cancer. Colonoscopy will definitely help to understand these problems (and eliminate some of them). And it is better not to wait for symptoms, and after 40-45 years to undergo a study.

Why and who needs it?

Inflammatory bowel disease (ulcerative colitis, Crohn’s disease, and others), premalignant and neoplastic lesions, diverticular bowel disease, chronic constipation, and even irritable bowel syndrome (IBS) require confirmation by colonoscopy.

There are a minimum of contraindications to the procedure, and all of them are associated with an extremely difficult condition of the subject (for example, acute phases of a heart attack and stroke, acute renal or liver failure, etc.). Even obstruction during bleeding from the colon, contrary to delusion, is not an obstacle.

Will it hurt?

Any endoscopic intervention is somewhat uncomfortable. At the same time, gastroscopy is virtually painless, but colonoscopy can cause pain. For example, if the patient has a too long intestine, or this organ is atypically located in the abdominal cavity, or there are adhesions in the abdomen after many operations (especially gynecological ones). Finally, the inexperience of the endoscopist sometimes causes pain.

According to those countries where anesthesia for colonoscopy is used only for special indications, the frequency of painful sensations that patients complain about is approximately 20%. Where health systems can afford to do sleep-in colonoscopies, people are more confident and willing to do repeat exams. Moreover, colonoscopy is a rather intimate procedure, and for many, embarrassment can become a barrier to diagnosis.

For the doctor, the main thing is to achieve the information content of the study, without being distracted by the patient’s lamentations. Therefore, it is better to carry out endoscopy under medical sleep.

It is safe?

The probability of complications of diagnostic colonoscopy is hundredths of a percent. More often they are associated with allergic reactions or gross anatomical disorders (serious postoperative changes, burns, injuries), which the patient did not report to the doctor, or he did not have experience in examining such patients.

Most complaints after colonoscopy are associated with bloating, which occurs due to excess air supply to the intestinal lumen, which is necessary to improve the examination. To avoid this, doctors in some clinics replace the air with carbon dioxide – it is quickly absorbed in the intestine, sterile and safe for electrical exposure (for example, when removing large polyps).

How to prepare for the procedure

A patient going for the first colonoscopy in his life should consult with an endoscopist – this will significantly improve the quality of preparation.

Step 1: Avoiding Certain Drugs. A few days before the study, drugs should be abandoned that stain the contents of the intestine in black, which makes visualization much worse. These are iron capsules, activated charcoal, bismuth preparations.

Step 2. Diet. Two days before the procedure, a “white” diet is allowed – foods that are completely absorbed (chicken breast, curds). The purpose of such a diet is to give the intestines time to “unload”, get rid of the ballast of undigested fragments. It is also required to completely eliminate plant fiber, since it remains in the intestine, interfering with the view and “clogging” the channels in the endoscope. The day before the study, you can only consume clear liquids – water, juice, tea, and even broth! Only after such a “cleaning” can one proceed to the next stage.

Step 3. Taking laxatives. Patients with prolonged constipation a couple of days before preparation are prescribed an additional laxative in suppositories – it stimulates the colon. But enemas will only hurt. It is enough for everyone else to take special preparations during the day, which are diluted in a large volume of water.