Colonoscopy

The colon, also called the large intestine or bowel, is the lower five to seven feet of the digestive tract. The colon turns intestinal waste into solid stool and assists in eliminating this material from the body. After you swallow food, it travels from the mouth through the esophagus to the stomach. Once broken down, the food moves from the stomach to the small intestine. The small intestine takes the nutrients from food, and the remaining indigestible portion moves into the colon. The colon stores the waste until the next bowel movement removes it from the body.

What is a colonoscopy?

A colonoscopy is a safe, effective procedure, which visually examines the lining of the colon and rectum using a long, flexible, tubular instrument attached to a camera and video monitor. It is used to diagnose colon and rectal problems, perform biopsies and remove colorectal polyps. The procedure usually takes less than an hour. There is little pain; however mild sedation is given when necessary to relieve anxiety and discomfort.

Who should have a colonoscopy?

Your health care provider may recommend a colonoscopy if you have a change in bowel habits or bleeding. A colonoscopy is the best screening test for colorectal cancer. Other indications for colonoscopy include the following:

• Evaluation of unexplained abdominal symptoms
• Diagnosis or evaluation of inflammatory bowel disease (colitis)
• Verify or treat findings of polyps or tumors located with radiologic studies (barium enema, CT scans, PET scans, or “virtual colonoscopy / colonography”)
• Evaluate patients with tests positive for blood in their stool
• Monitor patients with a history of colon polyps or cancer or with a family history of colon cancer or polyposis

Who performs a colonoscopy?

At Ochsner, a colonoscopy is performed by physicians in the Departments of Colon and Rectal Surgery and Gastroenterology.

How is the colonoscopy scheduled?

Any Ochsner providers can order a colonoscopy. Once ordered, the patient will be contacted by one of our Endoscopy Scheduling Nurses who will discuss your medical and insurance issues as well as provide instructions on the preparation. Additional information can be obtained by calling the Colon and Rectal Surgery Department at 504-842-4060 Gastroenterology Department at 504-842-4015

How is the colonoscopy performed?

The bowel must first be thoroughly cleared of all residue. As described below the preparation may be done in several ways. An intravenous line is inserted to allow administration of the sedative and pain medication. The colonoscope is inserted and advanced throughout the colon. During the examination, your physician may take pictures and will remove polyps or take biopsies as necessary. Following the colonoscopy, there might be slight discomfort, which quickly improves with the expelling of gas. Most patients can resume their regular diet later the day of the procedure. A friend or family member will need to drive you home because of the sedatives used during the procedure. You will not be allowed to provide your own transportation. Your physician will inform you of the initial results of the procedure. Biopsy results will not be available for several days and will be communicated to you by phone and letter. Your referring physician will also be informed.

Preparation

To clean out your colon, you will need to complete a bowel preparation prior to the procedure. The prep’s job is to quickly eliminate solid and liquid waste from the digestive tract leaving a clean colon that your physician can examine. Several preparations are available that flush out the colon using different methods:

PEG (polyethylene glycol) Lavage

• Two to four liters of nonabsorbable liquids that flush out waste matter. The smaller volume methods usually require additional use of laxatives and other fluids.

Sodium Phosphate Solution

• Two to three glasses of salt solution plus additional fluids. The solution works by drawing water into the colon and flushing out waste matter.

Sodium Phosphate Tablets

• Series of tablets (24 to 32) taken with clear liquids that draw water into the colon and flushing out waste matter

Most preps also involve dietary restrictions for a day or two before the colonoscopy. In addition, it's very important that you stay hydrated. Drink at least the amount of fluid required by the prep. Hydration before, during and after the prep and colonoscopy is also very important. General instructions for the preps used at Ochsner are listed below. Individual patient instructions may be different based on the type of prep proscribed, your medical conditions or the time of your exam.

Special Instructions

The following information is provided to assist patients in preparing for their colonoscopy. Several preparations are available and your physician and/or scheduling nurse will provide you with detailed instructions. Most combine dietary restrictions (usually a clear liquid diet) and medications to empty the colon of stool. Take your blood pressure and/or heart medications at 6:00 a.m. with a small sip of water the morning of your colonoscopy. If you are diabetic, check with your primary care doctor regarding insulin and oral medication adjustments prior to your scheduled procedure. Bring all your medications with you.

• Stop aspirin, Plavix, Aggrenox, Fish oil or Vitamin E seven to 10 days before colonoscopy
• Stop Coumadin three to five days before colonoscopy
• Stop Aleve, Naprosyn five days before colonoscopy
• Stop Advil, Ibuprofen, Motrin 12 hours before colonoscopy
• You may take Tylenol as needed

Since sedation is used during colonoscopy, it's necessary to have another person come with you to drive you home after the procedure. This person should be prepared to stay at the endoscopy unit for two to three hours. Your doctor will report to your accompanying person following the procedure. Someone should plan to stay with you for several hours after your return home following the procedure.

Clear Liquid Diet

To ensure a good and safe preparation it is important that you drink at least 64 oz of clear liquids a day during your preparation. Acceptable clear liquids include:

• Water, coffee or decaffeinated (no milk or cream)
• Tea, herbal tea
• Carbonated beverages (soft drinks), regular and sugar free
• Gelatin desert, plain or fruit flavored (avoid red gelatin)
• Apple juice, grape juice, cranberry juice, Juicy Juice
• Gatorade, Power Aid, Kool-Aid, lemonade, limeade
• Clear fat-free beef or chicken broth
• Bouillon, clear consommé
• Snowball (water-ice, flavored), popsicles
• Hard candy, sugar, salt
• Alcohol is not permitted

The following are alternate methods of colon cleansing:

Fleet Preparation - 3 oz

• Purchase four ducolax (bisacodyl) tablets and a 3 oz bottle of Fleets Phospho-Soda from the laxative section of your pharmacy or drugstore
• One day prior to your procedure (day of preparation), start a clear liquid diet
• At 12:00 p.m. (noon) take four ducolax tablets with eight or more oz of clear liquids
• At 3:00 p.m. add 1 ½ fl oz (three tablespoons) of Fleet Phospho-Soda to ½ glass of water or clear liquids (4 fl oz). This should be followed by five glasses (8 fl oz) of water or clear liquids.
• At 9:00 p.m. add 1 ½ fl oz (three tablespoons) of Fleet Phospho-Soda to ½ glass of water or clear liquids (4 fl oz). This should be followed by five glasses (8 fl oz) of water or clear liquids.
• It is important that you have nothing to eat for six hours prior to your procedure. After this you may drink water or clear liquids for two hours prior to your procedure. You should take nothing by mouth for the two hours prior to your procedure.

Osmo Preparation

• Fill your prescription for Osmo tablets at your local pharmacy
• One day prior to your procedure, start a clear liquid diet
• At 6:00 p.m. start taking four Osmo tablets every 15 minutes with at least 8 oz of clear liquids until you have taken 20 tablets
• At 8:00 p.m. start taking four Osmo tablets every 15 minutes with at least 8 oz of clear liquids until you have taken 12 additional tablets

Movi Preparation

• Fill your prescription for a Movi Preparation at your local pharmacy
• One day prior to your procedure (day of preparation), start a clear liquid diet
• At 12:00 p.m. (noon) take four ducolax tablets with 8 or more oz of clear liquids
• The MoviPrep carton contains four pouches and a disposable container for mixing. Empty one Pouch A and one Pouch B into the container and add lukewarm drinking water to the top line of the container. Mix to dissolve. You may refrigerate the solution prior to drinking, but the prep must be used within 24 hours of mixing.
• At 6:00 p.m. start drinking the solution. The container is divided by four marks. Every 15 minutes, drink the solution down to the next mark (approximately 8 oz), until the fill liter is complete. Drink 16 oz of additional clear liquids. Remix the two additional pouches into the container and add water.
• At 8:00 p.m. begin drinking the second bottle of the solution in the manner described above

Lavage Preparation

• Fill your prescription for a Lavage Preparation at your local pharmacy
• One day prior to your procedure (day of preparation), start a clear liquid diet
• At 12:00 p.m. (noon) take four ducolax (bisacodyl) tablets with 8 or more oz of clear liquids
• At 6:00 p.m. start drinking the lavage solution. Drink one 8 oz glass every 10 minutes until your bowel movements are clear.
• Lavage solution options: GoLylely, NuLytely, TryLyte, HalfLyghtly. Each of these solutions has a different volume and taste.

Problems & Questions About Your Preparation

After office hours ( 5:00 p.m. to 8:00 a.m.) you may call 504-842-3000 to speak with the On-Call resident for Colon and Rectal Surgery or Gastroenterology (depending on which type of physician is scheduled to perform your procedure).

What are the benefits and potential risks of having a colonoscopy?

With a colonoscopy, it's possible to detect and remove most polyps without abdominal surgery. A Colonoscopy is more accurate than x-rays in detecting polypos or early cancer. Polyps can usually be removed during the exam, a major step in the prevention of colorectal cancer. Many other disorders of the colon may also be identified including diverticular and inflammatory bowel disease. With any invasive procedure there are potential risks. The two most significant are bleeding and perforation. These are rare and usually identified during or shortly after the procedure. To schedule an appointment for a colonoscopy please call 1-866-OCHSNER, or consult with your primary care physician.