Colonoscopy

A colonoscopy is an exam of the lower part

of the gastrointestinal tract, the colon or
large intestine (bowel).
Colonoscopy is a safe procedure that
provides information other tests may not
be able to give.

DESCRIPTION
Colonoscopy allows inspection of the mucosa of the
entire colon, ileocecal valve & terminal ileum using
a flexible fiberoptic colonoscope inserted through
the anus & advanced to the terminal ileum.

 The colonoscope is a multichannel instrument that

allows viewing of the gastrointestinal (GI) tract lining,
insufflation of air, aspiration of fluid, obtaining of
tissue biopsy samples & passage of a laser beam for
obliteration of tissue and control of bleeding.
Mucosal surfaces of the lower GI tract are examined
for ulcerations, polyps, chronic diarrhea, hemorrhagic
sites, neoplasms & strictures.

 During the procedure, tissue samples may

be obtained for cytology & some
therapeutic procedures may be performed
(such as excision of small tumors or
polyps, coagulation of bleeding sites, and
removal of foreign bodies).

INDICATIONS
Specific
Diagnostic
Therapeutic

SPECIFIC INDICATIONS
Investigation of overt or occult
bleeding
Abnormal radiological imaging
Irritable bowel syndrome
Inflammatory bowel disease
Colorectal cancer screening
Polypectomy surveillance

DIAGNOSTIC
INDICATIONS

Rectal bleeding (overt/occult)

Iron deficiency anemia
Chronic diarrhea
New/worsening constipation
Abnormality on CT scan, PET scan or barium enema
Surveillance in chronic ulcerative or Crohns colitis
Surveillance after removal of neoplasm
Unexplained abdominal/pelvic pain
CRC screening
Idiopathic colitis: determine of disease extent/activity
and/or response to therapy
Intraoperative identification of previously identified lesion
not apparent at surgery

THERAPEUTIC
INDICATIONS

Removal of foreign body

Excision of polyp
Treatment of acute or chronic colonic bleeding
Decompression of colonic pseudo-obstruction
Decompression of volvulus
Intramucosal injection of drug
Dilatation/stenting of symptomatic colonic
stricture (either begin/malignant)
Marking (tattooing) site of lesion before
surgical resection

CONTRAINDICATIONS
ABSOLUTE

Toxic megacolon
Fulminant colitis
Free colonic perforation
Patient refuses consent
Patient cannot cooperate
with the procedure

RELATIVE
Acute diverticulitis
Inadequate colonic
cleansing
Recent MI, pulmonary
embolism or clinical
instability for any other
cause
Immediately post-colonic
surgery (recent
anastomosis)
Severe coagulopathy

NORMAL FINDINGS
Normal intestinal mucosa with no
abnormalities of structure, function,
or mucosal surface in the colon or
terminal ileum.

Sample image set showing a colonoscopy of a normal colon.

ABNORMAL FINDINGS

Bleeding sites
Benign lesions
Bowel distention
Bowel infection or inflammation
Colon cancer
Crohns disease
Colitis
Diverticula
Foreign bodies
Hemorrhoids
Polyps
Proctitis
Tumors
Vascular abnormalities

Left: Rectal variceal active bleeding (arrow) treated with

band ligation.
Right: Following immediate cessation of bleeding, the
bleeding point is seen at the apex of the banded varix
(arrow).

 Example of colonic stenosis from a benign

process (left) or a malignant one (right).

 Erythematous mucosa in the colon, defined as an increased redness of the mucosa, due to
an increase in its hemoglobin content because of increased blood flow (left), which should be
distinguished from a congested mucosa, defined as a swelling of the mucosa due to an
increase in the mass of the mucosa, occuring most often in association with an inflammatory
process where permeability of cell membranes is altered & the extracellular osmolarity is
modified (right).

 Erosions of the rectal mucosa (left) and

typical aphthae (right).

 Similar elements describable by the same aggregate of words (ulcers,

erythema, congested mucosal) can represent different clinical
diagnoses (left, ulcerative colitis; right, Crohns disease). Structured
language manages this by following the descriptor words with the
probable specific diagnosis.

A depressed lesion with marginal elevation (type IIc + IIa) in

the transverse colon, 9 mm in diameter.
(a) Ordinary colonoscopic view.
(b) Chromoendoscopy with indigo carmine.

REFERENCES
Colonoscopy: Principles and Practice,
2nd Edition, J. D. Waye, Wiley
Blackwell
American College of Surgeon,
Surgical Patient Education,
www.facs.org/patienteducation