A patient who has known diverticular disease may present a problem for the inexperienced endoscopist. The diverticula look like the bowel lumen but in fact are blind ends; it takes a skilled endoscopist to negotiate the diverticular bowel. The examination is usually one where diverticular disease is an incidental finding. The investigation is not one of choice in the acute stage because of the risk of the perforation with the endoscope.
Colonoscopy is a procedure where a flexible fibreoptic tube is inserted into the rectum via the anus to visualize the whole of the large bowel, the rectum, the sigmoid colon, the ascending colon, the transverse colon and the descending colon ending at the caecal valve. The procedure is carried out with the patient under mild sedation.
Colonoscopy is a procedure that is performed to visualize the mucosal lining of the bowel, to enable the endoscopist to take biopsies and snare any polyps that are seen, and to take photographs of the bowel whether a normal or abnormal mucosa is visualized on a monitor.
The procedure requires the bowel to be cleansed using bowel preparation, enabling clear views of the bowel to be obtained. All endoscopy departments will have their own preferred method to cleanse the bowel. Bowel preparation necessitates a method of cleansing usually in the form of a purgative and plenty of clear fluids 24 hours before the start of the procedure.
The actual procedure can be performed with or without mild sedation depending on the endoscopist's and patient's preference. Many patients are unable to tolerate the fibreoptic scope as it wends its way around the bowel, and sedation is vital for this group of patients.
Colonoscopy is performed with the patient lying on his or her left side with the knees bent up. A digital rectal examination should be performed first. The scope is placed into the anus and the flexible fibreoptic tube gently fed into the bowel. The endoscopist watches the procedure on a monitor and visualizes the bowel lumen as the scope threads its way around the bowel. The scope is made up of a main channel with fibreoptic capabilities; alongside this are two other tubes allowing water and air to be inserted into the bowel. The water tube allows the endoscopist to clear debris and the air tube allows insertion of air to open up the lumen and removal of the air. Biopsy forceps can be passed within the tube to allow the taking of a biopsy of bowel mucosa or to remove polyps.
The patient has his or her pulse and oxygen levels monitored throughout the procedure to ensure that there are no adverse reactions to the drugs or the procedure. If the procedure proves difficult or there is an impassable stricture, the patient can go directly to the radiology department for a barium enema or CT pneumocolon.
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