Frequently Asked Questions
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Colonoscopy
1. WHAT IS A COLONOSCOPY?

Answer:
Colonoscopy is a procedure that allows the doctor to visually examine the entire lining of the colon and rectum using a colonoscope (a long flexible tube about the thickness of a finger). The colonoscope is inserted into the rectum and gradually advanced through the colon. The doctor is able to
carefully examine the lining of the rectum and diagnose colon and rectal problems, perform biopsies, and remove polyps.

2. WHO SHOULD HAVE A COLONOSCOPY?

Answer:
The doctor may recommend a colonoscopy to:
• Screen the colon at age 50 or earlier if there is a family history of colon cancer.
• Examine and possibly remove polyps or tumors located by a barium enema exam.
• Monitor patients with a past history of colon polyps or cancer, or with a strong family history of colon cancer.
• Examine patients who test positive for blood in the stool.
• Check inflammatory bowel disease (colitis).
• Check unexplained abdominal symptoms or change in bowel habits.
• Identify cause of unexplained bleeding.

3. HOW IS A COLONOSCOPY PERFORMED?

Answer:
A colonoscopy is done in an outpatient setting. Patients take an oral preparation to cleanse the bowel the day before the procedure. The colonoscope is inserted into the rectum and gradually advanced through the colon. The doctor may inject
medicine to relax the patient and help ease any discomfort. Colonoscopy is done under sedation not anesthesia. The entire procedure usually takes less than an hour. The patient usually may resume normal activities the following day.

4. WHEN IS A BIOPSY DONE?

Answer:
If the doctor sees an area in the bowel that needs further evaluation, a biopsy forceps can be passed through the colonoscope to take a sample of tissue (biopsy). This sample will be sent to the hospital lab. Biopsies are taken for many reasons and do not necessarily mean that cancer is suspected.

5. WHAT IS A POLYPECTOMY?

Answer:
Polypectomy is the removal of a polyp. During the course of the examination, a polyp may be found. Polyps are abnormal growths of tissue which vary in size from a tiny dot to several inches. If the doctor feels that removal of the polyp is indicated, a wire loop or snare will be passed through the colonoscope and the polyp removed from the intestinal wall using an electrical current. If additional polyps are detected, they may be
removed as well. Polyp removal is not painful.

Polyps are usually removed because they can cause bleeding, contain cancer, or be a precursor of cancer. Although the majority of polyps are benign (non-cancerous), a small percentage may contain an area of cancer in them or may develop into cancer. Removal of colon polyps therefore
is an important means of prevention of colon cancer, a leading form of cancer in the United States.
Click here for more information on colon polyps.

6. WHAT ARE THE RISKS OF COLONOSCOPY?

Answer:
• Bleeding
• Perforation

Upper Endoscopy (EGD)

7. What is an upper endoscopy (EGD)?

Answer:
An upper endoscopy is a procedure that allows a physician to examine the upper part of the gastrointestinal (GI) system, which includes the esophagus (swallowing tube), the stomach, and the duodenum (the first section of the small intestine)

8. What are the most common reasons for upper endoscopy?

Answer:

• Persistent nausea and vomiting
• Upper abdominal pain, heartburn, or acid reflux symptoms (an acid or burning sensation in the throat or chest)
• GI bleeding (vomiting blood or blood found in the stool)
• Difficulty swallowing; food/liquids getting stuck in the esophagus
• Abnormal or unclear findings on an upper GI x-ray
• Removal of a foreign body
• To follow-up on previously found polyps (growths), tumors, or ulcers

9. What happens prior to the upper endoscopy?

Answer:
Prior to the endoscopy, a nurse will ask questions to ensure the patient understands the procedure and the reason it is planned. The nurse will ask questions to ensure the patient has prepared properly for the procedure. A doctor will also review the procedure, including possible complications, and will ask patients to sign a consent form. The nurse will start an intravenous line (insert a needle into a vein in the hand or arm) to administer medications. The intravenous line insertion feels like a pin prick, similar to having blood drawn. Most endoscopy units use a combination of a sedative (to help patients relax), and a narcotic (to prevent discomfort). The vital signs (blood pressure, heart rate, and blood oxygen level) will be monitored before, during, and after the examination. The monitoring is not painful. Some patients will be given oxygen during the examination. For safety reasons, patients will be asked to remove dentures.

10. What is the procedure like?

Answer:
The procedure typically takes between 10 and 20 minutes to complete. The endoscopy is performed while the patient lies on their left side. Some patients will be given a medication to numb the throat (either a gargle or a spray). A plastic mouth guard is placed between the teeth to prevent damage to the teeth and scope. The endoscope is a flexible tube with a lens and a light source that allows the endoscopist to either look into the scope or at a TV monitor. If the image is reflected on a TV monitor, it is magnified many times so the endoscopist can see minute changes in tissue. The patient will be asked to swallow the tube; many patients do not remember this after the medications have taken effect. Most patients have no difficulty swallowing the tube as a result of the sedating medications. Many people sleep during the test; others are very relaxed and generally not aware of the examination. The endoscopist may take tissue samples (biopsies) or perform specific treatments (such as dilation, removal of polyps, treatment of bleeding), depending upon the reason for the procedure and what is found during the examination. These treatments are not painful. Air is introduced through the scope to open the esophagus, stomach, and intestine, allowing the scope can be passed through these structures and improving the endoscopist's ability to visualize all of the structures. Patients may experience a mild discomfort as air distends the tissue. This is not harmful and belching may relieve the sensation. The endoscope does not interfere with breathing. Taking slow, deep breaths during the procedure may help a patient to relax.

11. What happens after my procedure?

Answer:
After the endoscopy, patients will be observed for one to two hours while the sedative medication wears off. The medicines cause most patients to feel tired or have difficulty concentrating, and patients should not drive or return to work after the procedure. The most common discomfort after the examination is a feeling of bloating as a result of the air introduced during the examination. This should resolve quickly. Some patients also have a mild sore throat. Most patients are able to eat a few hours after the examination.

12. What are the risks of an Upper Endoscopy?

Answer:
Upper endoscopy is a safe procedure and complications are uncommon. The following is a list of possible complications:

• Aspiration of food or fluids into the lungs, the risk of which can be minimized by refraining from eating or drinking for several hours before the examination.

• The endoscope can cause a tear or hole in the tissue being examined. This is a serious complication but fortunately occurs only very rarely.

• Bleeding can occur from biopsies or the removal of polyps, but it is usually minimal and stops quickly on its own or can be easily controlled.

• Reactions to the sedative medications are possible; the endoscopy team (doctors and nurses) will ask about previous medication allergies or reactions and about health problems such as heart, lung, kidney, or liver disease. Providing this information to the team ensures a safer examination.

• The medications can also produce irritation in the vein at the site of the intravenous line. If redness, swelling, or warmth occurs, warm wet towels applied to the site may relieve the discomfort. If discomfort persists, a patient should call their primary care provider or the endoscopy unit. If this is not possible, the patient should seek assistance in an emergency department.

The following signs and symptoms should be reported immediately:

• Severe abdominal pain (more than gas cramps)
• A firm, distended abdomen
• Vomiting
• Temperature greater than 101ºF or 38ºC
• Difficulty swallowing or severe throat pain
• A crunching feeling under the skin. .