Understanding Colonoscopy

What is colonoscopy?
A colonoscopy is a medical procedure performed under mild anesthesia where Dr. Sinha, a board certified, licensed, gastroenterologist, passes an endoscope (or colonoscope) a thin, flexible, tubular instrument about a half inch in diameter with a camera and light attached to the end of it through your anus and rectum, into your entire large intestine (or colon). Carbon dioxide (CO2) or air will be inserted into your colon to inflate your colon so that Dr. Sinha can view the lining of your large intestine more thoroughly and navigate her scope appropriately. Images of your colon will be displayed on a monitor while Dr. Sinha conducts the procedure.

Colonoscopy is routinely performed and typically takes less than 30 minutes to complete. It is an ideal screening test for colorectal cancer, because it allows Dr. Sinha to both detect and remove colon polyps all at once. If any polyps are discovered during the procedure, Dr. Sinha will remove these, and takes biopsies of any suspicious tissue.

Risks associated with the procedure include, but are not limited to: missed lesions, bleeding, a reaction to the medication or anesthesia that is given to you, and perforation.

Where will I have the procedure performed?
We offer the procedure at one of two locations depending on your preference and your insurance coverage. Options include: the Somerset Ambulatory Surgical Center in Hillsborough or the Hunterdon Medical Center in Flemington (click here for a link to directions to these facilities).

Are there risks associated with the procedure?
As with any medical procedure, there are risks associated with colonoscopy. Risks include, but are not limited to: missed lesions, bleeding, a reaction to the medication or anesthesia that is given to you, and perforation.

What is an open assess colonoscopy?
Open Access Colonoscopy is a service that allows healthy, age-appropriate patients to easily schedule colonoscopy. We require a pre-procedure initial office consultation for ALL patients prior to screening colonoscopy. This allows us to can obtain a complete medical and surgical history, perform a physical exam, identify if screening colonoscopy is right for you, and ensure that you are safe before, after, and during your procedure.

I turned 50 and my family doctor told me I need a colonoscopy. How can I schedule this?
Please call our office at 908-788-8200 to schedule your initial consultation.

Why can’t I just schedule the procedure? Why do I need an initial consultation?

Screening colonoscopy is not appropriate for everyone. At your initial consultation we will review your medical history and determine what screening procedures are most appropriate for you. During this visit we take a complete past medical and surgical history to make sure that it is safe to put you under anesthesia. Some individuals will require clearance from their primary care providers or other specialists before being put under anesthesia. You may need to go to the hospital to have certain tests like a chest x-ray or EKG done before your procedure. If you are obese, have sleep apnea, wear a C-PAP or have had difficulty with anesthesia in the past, you may need to meet with the anesthesiologist in a separate consultation prior to your colonoscopy.

Please come prepared with a list of all of your current medications, allergies, past surgical history, and family history. Different screening recommendations may be made if you have a family history of colorectal cancer or other genetic syndromes. If you have a history of multiple abdominal surgeries, we may recommend that a pediatric sized scope be used for your procedure. At the initial consultation all of these details will be discussed and addressed.

Please notify our office of all of your medical conditions prior to your procedure including but not limited to: prior surgeries, high blood pressure, diabetes, sleep apnea, personal history of heart attack or stroke, cancer, lung disease, kidney disease, liver disease, thyroid disease, infectious disease, valvular heart disease, irregular heartbeat, atrial fibrillation, blood clot, if you have a pacemaker or other electro-medical devices, if you are taking any over-the-counter, herbal or prescription medications, if you are taking any anti-inflammatory medications, NSAIDs, Aspirin, fish oil, Vitamin E, iron supplementation, or other blood thinners, and if you are undergoing treatment for any other medical condition at this time.

You may have to take antibiotics prior to your colonoscopy if you have an artificial heart valve or if you have ever been told that you have to take antibiotics before a dental or surgical procedure. If you’re a diabetic or are on any blood thinning medications, these medications may need to be adjusted prior to you procedure.

How do I prepare for colonoscopy?
In the days leading up to your colonoscopy you will be instructed to modify your diet to avoid foods that are slow to digest, to initiate a clear liquid diet for 24 hours prior to your procedure, and to take a “bowel prep” to flush out the contents of your colon so that Dr. Sinha will be able to view the entire lining of your colon clearly, allowing her to identify any abnormalities in the wall of the colon including polyps, ulcerations, masses, or other abnormalities.

What position will I be in?
During your colonoscopy, Dr. Sinha, a surgical nurse or team or nurses, and a board-certified anesthesiologist will be in the room with you.

Will I be sleeping during the procedure?
Yes. For your safety and comfort, we use MAC sedation, where board certified anesthesiologists monitor you before, during, and after your procedure.

For years, doctors used a combination of sedation drugs such as fentanyl, meperidine and midazolam during a colonoscopy. These drugs can last in your body for hours, and have shown not to work in certain patient subsets including younger patients and those with a history of drug or alcohol use.

MAC sedation provides safe and effective conscious sedation, anxiety control, and pain control. It carries fewer side effects with it, and has a quicker recovery period than general anesthesia and some of these older forms of conscious sedation.

MAC sedation works quickly and is reversed quickly. Recovery time is less. You can arrive for your procedure, have your procedure done, and walk out shortly afterwards. A driver is still required, and you will not be able to operate any machinery or make any important decisions for 24 hours after your procedure because you will have been sedated; however, most patients will be able to walk out of the procedure and go about a semi-normal day afterwards. We advise you to take it easy and not to return to work for a full day after your colonoscopy.

Do I have to be sedated?
Some patients ask not to be sedated. We do not advise this, as the procedure is painful if you are not appropriately sedated.

Should you choose not to use MAC sedation, as a board certified gastroenterologist Dr. Sinha is fully qualified to provide alternative forms of conscious sedation for you. Other forms of sedation can have more side effects associated with them and carry a longer recovery period. We understand that not all patients have the same medical needs, requirements, and/or desires, which is why we offer comprehensive personalized care with your safety and comfort being our utmost priority. We encourage you to discuss all of your options for care with us at your initial consultation, and with your board certified anesthesiologist prior to your procedure.

Will I be comfortable?

In order to ensure you are both comfortable and safe during the procedure we use MAC anesthesia administered by board certified anesthesiologist. Additionally, we use carbon dioxide (or CO2) instead of air to inflate your colon at the Somerset Ambulatory Surgical Center. During colonoscopy, either CO2 or air is used to inflate the colon so that Dr. Sinha can visualize your colon more thoroughly and navigate her scope. Many patients experience pain or discomfort after colonoscopy as a result of inflated gas retained in the colon. Using CO2 in lieu of air reduces the amount of gas retained, resulting in less pain and discomfort for you, less embarrassing gas, and improved overall satisfaction following the procedure.

I’ve been told the bowel prep is the worst part…why?
In the days leading up to your colonoscopy you will be instructed to modify your diet to avoid foods that are slow to digest, to initiate a clear liquid diet for 24 hours prior to your procedure, and to take a “bowel prep” to flush out the contents of your colon so that Dr. Sinha will be able to view the entire lining of your colon clearly, allowing her to identify any abnormalities in the wall of the colon including polyps, ulcerations, masses, or other abnormalities.

The prep certainly is not fun. Following a clear liquid diet for 24 hours can be difficult. Keep in mind, the purpose of the bowel prep is to clean out your large intestine so that Dr. Sinha can thoroughly view the lining of your large intestine. If stool or sludge is left in your colon, lesions can be obscured and missed.

Once you start taking your prescribed course of laxatives you will need to stay close to a bathroom. Significant diarrhea will result. Eventually you will start to pass water. Stay hydrated. Continue to drink plenty of fluids through the course of your prep. If you experience discomfort or burning around your anus, you can use Vaseline and/or unscented baby wipes instead of toilet paper to help with the discomfort.

Are there different bowel preps?
Yes, we use several different types of bowel preps based on your coexisting medical conditions, personal preference, and insurance coverage. Some bowel preps require that you drink a large amount of liquid; others require that you drink a smaller amount of liquid. Still others require that you take pills. Bowel prep options will be discussed at your initial consultation and the safest, most appropriate option for you will be selected at your appointment.

Why is the bowel prep so important?
If your colon is not effectively cleaned out, lesions and polyps can be obscured or masked by stool or sludge, and missed. Following your bowel prep instructions is crucial! If you have any confusion about how or when to start your prep, please do not hesitate to call our office at 908-788-8200.

Please notify our office if you have any history of constipation or slowed digestion at your initial consultation or if your prep does not appear to be working. Sometimes individuals may require an extended bowel prep to help ensure that the colon is effectively cleaned out prior to colonoscopy.

What should I expect afterwards?
You will stay in a recovery room for about 30 minutes after your procedure for observation. You may feel some cramping or a sensation of having gas, but this will typically pass quickly. The use of CO2 in lieu of air to inflate your colon should help to minimize embarrassing gas and discomfort. Unless you are told otherwise, you will be able to resume your normal diet immediately afterwards.

Can I go back to work?
Not that day because you will still be under the effects of the anesthesia administered to you, but the following day, yes, so long as the procedure was uncomplicated.

Why do I have to have a driver?
Make sure you arrange for a driver to bring you home after your colonoscopy. Because you will be receiving sedating medication for the procedure, it is unsafe for you to drive or operate machinery any for 24 hours after the procedure.

What complications can occur?
Risks associated with the procedure include missed lesions, bleeding, a reaction to the medication or anesthesia that is given to you, and perforation or puncture of the colon. Bleeding and perforation are rare but possible complications of colonoscopy.

Go to your nearest emergency room and notify our office immediately if you have any concerns after your procedure or if you develop bleeding, severe pain, fevers, chills or sweats.

Why do I have to have a follow-up office visit if you don’t find colon cancer?
Depending upon what is found during your colonoscopy will dictate the guidelines for when your next screening colonoscopy should be performed. A screening colonoscopy is performed as a preventative measure in someone who doesn't yet have signs or symptoms of disease. The purpose of a screening test is early detection. It is used to help reduce the risk of disease. In the case of screening colonoscopy, it is used to detect and remove polyps before they have a chance to turn into invasive colorectal cancer, and to detect colorectal cancer early enough when it can be treated most effectively.

If polyps are found colonoscopy during your colonoscopy, repeat surveillance colonoscopy will be recommended sooner based on the number of polyps found and the types of polyps found. This will be discussed at your follow up visit. Immediately after your procedure you may still be drowsy and not remember all of the information relayed to you. It’s important to keep your post-colonoscopy follow-up visit to make sure that you understand completely what was discovered during your procedure, to review any biopsy or pathology results of samples taken, and to set up a schedule for when your next screening colonoscopy or other testing should be performed.

Please note pathology results are not available immediately and can take up to two weeks to receive.

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