Colonoscopy

Colonoscopy is a procedure that allows Dr Noushi to examine the inner lining of the colon. A soft, bendable tube about the thickness of the index finger is gently inserted into the anus and advanced through the rectum and the colon. This procedure requires anaesthesia and is always done in hospital or day surgery.

The indication for colonoscopy includes the following:

Routine screening for cancer especially after a positive faecal occult blood test
Removal of polyps or a follow-up after previous polyp removal
Evaluate the colon for a change in bowel habits or bleeding
Follow-up after previous surgeries
Evaluate changes in the lining of the colon known as inflammatory disorders.

The procedure is usually well tolerated, but there is often a feeling of pressure, gassiness, bloating or cramping at various times during the procedure. The anaesthetist will give you medication through a vein to help you relax and better tolerate any discomfort that you may experience. You will be lying of your side or your back while the colonoscope is advanced through the large intestine. The lining of the colon is examined carefully while inserting and withdrawing the instrument. The procedure usually lasts for 20 to 60 minutes. In rare instances the entire colon cannot be visualized and Dr Noushi may request further investigation.

You will be sedated (anaesthesia) for the colonoscopy and you must make arrangments for someone to dive you home after the procedure. Anaesthesia will affect your judgment and reflexes for the rest of the day. You should not drive or operate machinery until the next day.

If Dr Noushi sees an area that needs more detailed evaluation, a biopsy may be obtained and submitted to a laboratory for analysis. Placing a special instrument through the colonoscope to sample the lining of the colon does this. Polyps are generally removed. Polyps are either benign (non-cancerous) or cancerous, but one cannot always tell by the appearance alone. They can be removed by burning (fulgurating) or by a wire loop (snare). It may take Dr Noushi more than one sitting to do this if there are numerous polyps or they are very large. Sites of bleeding can be identified and controlled by injecting certain medications or coagulating (burning) the bleeding vessels. Biopsies do not imply cancer, however, removal of a colonic polyp is an important means of preventing colorectal cancer.

You will need to purchase 3 sachets of PICOPREP from your chemist. Allow a few days for your pharmacist to order this if necessary. Alternatively if this not available then purchase 3 satchets of Picolax. The success of your examination depends on the bowel being as clear as possible, otherwise the examination may need to be postponed and the preparation repeated. If you are unable to take the preparation please contact Dr Noushi’s rooms or the hospital.

Stop all Iron containing medications at least one week prior to your procedure. All blood thinning medications (eg Aspirin, Warfarin, Plavix, Iscover) may need to be ceased prior to your procedure and should be discussed with your doctor. You can continue with any other regular medications. It is also essential that you alert Dr Noushi and his anaesthetist if you require antibiotics prior to undergoing dental procedures, since you may also require antibiotics prior to this procedure (eg for patients with artificial heart valves). Please take your regular medications during the fasting period with just a sip of water. If you take the oral contraceptive pill, you must use additional barrier methods until the next period, as the pill’s absorption is affected by diarrhoea.
3 Days prior to the test, begin your preparation with a Low Fiber Diet. Especially avoid food with seeds and grains such as muesli or wholegrain bread. (See below)
The day before your procedure, you should have no solid food at all. You can drink from the approved liquids listed below as much as you like.
At around 1.00pm in the afternoon on the day before you need to commence the “Picoprep” bowel preparation. Mix one sachet in a glass of water and drink it all. Drink another 3 to 4 glasses of water or clear fruit juice immediately after drinking the Picoprep. Take the next sachet at around 4.00pm and the final sachet at 7.00pm. Make sure you keep drinking in between each sachet of Picoprep. The more you drink, the better the medication will work.
Individual responses to laxatives do vary. This preparation may cause multiple bowel movements. It usually induces frequent, loose bowel movements within two to three hours of taking the first dose. Please remain within easy reach of toilet facilities.
If you start to feel nauseated while drinking the preparation, slow down the rate of intake. It is important that you finish all of the preparation.
Once this solution has been commenced you are to drink clear fluids only until 6 hours before the procedure. See the list on below for approved clear fluids. Do Not consume milk, alcohol, solids or sugar during this period. Before the procedure, you must fast completely (no food or drink) for at least 6 hours.
WHAT HAPPENS AFTER COLONOSCOPY?
Dr Noushi will explain the results to you after your procedure or at your follow up visit. You may have some mild cramping or bloating from the air that was placed into the colon during the examination. This should quickly improve with the passage of the gas. You should be able to eat normally the same day and resume your normal activities after leaving the hospital. Do not drive or operate machinery until the next day, as the sedatives given will impair your reflexes.

If you have been given medication during the procedure, you will be observed until most of the effects of the sedation have worn off (1-2 hours). You will need someone to drive you home after the procedure. If you do not remember what Dr Noushi told you about the examination or follow up instructions call Dr Noushi’s rooms for further instruction.

If polyps were found during your procedure, you will need to have a repeat colonoscopy. Dr Noushi will decide on the frequency of your colonoscopy exams.

Dr Noushi will explain the results to you after your procedure or at your follow up visit. You may have some mild cramping or bloating from the air that was placed into the colon during the examination. This should quickly improve with the passage of the gas. You should be able to eat normally the same day and resume your normal activities after leaving the hospital. Do not drive or operate machinery until the next day, as the sedatives given will impair your reflexes.

If you have been given medication during the procedure, you will be observed until most of the effects of the sedation have worn off (1-2 hours). You will need someone to drive you home after the procedure. If you do not remember what Dr Noushi told you about the examination or follow up instructions call Dr Noushi’s rooms for further instruction.

If polyps were found during your procedure, you will need to have a repeat colonoscopy. Dr Noushi will decide on the frequency of your colonoscopy exams.

Colonoscopy and biopsy are safe when performed by surgeons who have had special training and are experienced in these endoscopic procedures. Complications are rare, however, they can occur. The complications of colonoscopy include (but not limited to) bleeding from the site of a biopsy or polypectomy and a tear (perforation) through the lining of the bowel wall. Should this occur, it may be necessary for your surgeon to perform abdominal surgery to repair the intestinal tear. Blood transfusions are rarely required. A reaction to the sedatives can occur. Irritation to the vein that medications were given is uncommon, but may cause a tender lump lasting a few weeks. Warm, moist towels will help relieve this discomfort.

It is important to contact Dr Noushi if you notice symptoms of severe abdominal pain, fevers, chills or rectal bleeding of more than one-half cup. Bleeding can occur up to several days after a biopsy.