Module: Understanding and Preparing for Colonoscopy
Expert Video - What is a colonoscopy?

A colonoscopy is a medical procedure that allows doctors to look inside the inner lining of the colon and rectum in order to evaluate colon health and look for colon cancer. A colonoscopy helps find problems such as ulcers, inflammation, bleeding, polyps and tumors. The experts explain that colonoscopy is used as an early cancer screening tool in patients who have no symptoms, and in patients who already have symptoms it is used to evaluate and diagnose what the problem might be. Colonoscopy is also used in patients with inflammatory bowel disease (ulcerative colitis and Crohn’s disease) and in patients who have unexplained symptoms such as blood in their stool, to make sure there is no cancer, mucosal disease, polyp, or even tumor.

Expert Video - Why is a colonoscopy important?

Expert gastroenterologists Drs. Andres Gelrud and Juan Echavarria explain the important role that colonoscopy plays in significantly decreasing the incidence of colorectal cancer. Colonoscopy is a preventative measure for finding and removing polyps that over time can potentially become cancer. A colonoscopy can also find cancer early, when treatment is most effective and your doctor has a better chance of curing the disease. Precancerous polyps and early colorectal cancer don’t always cause symptoms, especially at first. This means that someone could have polyps or colorectal cancer and not even know it. That is why having a colonoscopy is so important.

Expert Video - Is a colonoscopy safe?

In this video, Dr. Gelrud and Dr. Echavarria talk about how a colonoscopy is a generally safe procedure and complications are rare. There can be a very small risk of bleeding, puncture in the bowel wall, infection, and drug reactions - but these are very rare. You should always discuss any questions or concerns you have about your colonoscopy, results, and post-procedure with your doctor. Your doctor is there to help you through the process and answer any questions you may have.

Expert Video - What does the colon do?

The colon plays an important role in the digestive system. In this video, gastroenterologists Drs. Echavarria and Gelrud explain some of the colon’s important functions - such as the absorption of water from undigested food to produce stool (feces), the accumulation and delivery of stool to the rectum prior to a bowel movement, and the absorption of certain nutrients that are important for the maintenance of good health. Additionally, the experts discuss how a colonoscopy procedure is helpful in cases where the colon is diseased, inflamed, or infected, and to screen for colon cancer.

Expert Video - Who should get a colonoscopy and when?

In this video, Dr. Echavarria and Dr. Gelrud explain who should get a colonoscopy, and when. Routine screening colonoscopy should begin at age 50 in men and women who have normal risk for colon cancer and no symptoms. Colonoscopy should be started earlier if you have symptoms or family history of colon cancer, precancerous polyps, or inflammatory bowel disease. Colonoscopy is also used for other diseases that affect the overall health of the bowel, such as inflammatory bowel disease, diverticulitis, and ulcers. Talk to your doctor about the appropriate time for you to have a colonoscopy. Be sure to discuss any symptoms, family history of colon cancer, or other bowel diseases with your doctor. With this information your doctor can determine if you need to get a colonoscopy earlier, more frequently, or if there are any genetic predispositions that put you at higher risk.

Expert Video - What can I eat or drink before a colonoscopy?

Colonoscopy bowel prep is a two-step process that involves dietary restrictions and taking a bowel prep medication. In this video, Dr. Echavarria and Dr. Gelrud discuss the dietary restrictions that are required before a colonoscopy. Three days before your colonoscopy, you will need to begin a low residue diet of foods that are very low in fiber and easy to digest (e.g., white bread, rice and pasta, plain crackers, canned fruit, lean meats without skin, and eggs). Do not eat seeds, green vegetables such as broccoli, cauliflower, kale, cabbage, and do not have dairy, or certain juices like prune juice. One day before - and the day of - your colonoscopy you will need to limit your diet to clear liquids only (e.g. clear broth, black tea or coffee, clear, light-colored juices, clear soft-drinks, clear sports drinks, plain gelatin without fruit, pulp-free juice bars, and water). Do not drink alcohol, liquids you can’t see through, dairy products, or red or purple liquids (these colors may be confused for blood during the colonoscopy). On the day of your colonoscopy, do not drink anything two hours before your procedure.

Expert Video - What does bowel prep involve?

Before your colonoscopy procedure, you will need to cleanse your bowel completely. This is called bowel preparation (or bowel prep), and it is the most important requirement for a successful colonoscopy. As Dr. Gelrud and Dr. Echavarria explain, a good bowel prep done by you will allow a good colonoscopy examination to be performed by your doctor. A well-cleaned colon lets your doctor see clearly inside your colon for polyps or other abnormalities. A poorly cleaned colon will obscure your doctor's view, making it easy to lose and miss polyps or abnormalities that can over time become cancer. The bowel prep process includes dietary restrictions and taking a bowel prep medication. Dietary changes play an important role because certain foods, like vegetables, can be seen in the colon during a colonoscopy. Dietary changes include a low residue diet (low fiber) a few days before your colonoscopy, and a clear liquid diet the day before and the day of your colonoscopy. Before your colonoscopy procedure, your doctor will give you the exact diet and bowel prep instructions you need to follow. Make sure you fully read the instructions ahead of time and that you plan accordingly.

Expert Video - What are bowel prep medications?

Before you go for your colonoscopy, you will need to drink a bowel preparation medication (often called bowel prep) to clean out your colon. Bowel preps are prescription and over the counter medications that cause diarrhea for several hours, in order to flush the stool out of your colon and leave it clean so that your doctor can optimally examine the lining of your colon. Bowel prep medications require that you drink large volumes of clear liquid and stay well hydrated during the process. There are several types of bowel prep medication, so talk to your doctor about which one is right for you. It is very important to tell your doctor if you have heart disease, diabetes, or a kidney condition because each of these will affect the kind of bowel prep that you need. Some tips to help make drinking bowel prep easier include: chill your medication in the refrigerator beforehand, drink your medication through a straw, add flavor to help it taste better, and very importantly, plan ahead. Plan to stay home during your bowel prep, and stay near a bathroom for a few hours until the effects of your prep medication have worn off. It is very important to drink lots of water or clear liquids before and after your colonoscopy. However, do not drink anything up to 2 to 4 hours before your procedure, depending on the instructions your doctor provides. Before that, you can drink as much water or clear liquid as you wish. A successful colonoscopy cannot be done without a complete and thorough bowel cleansing, so be sure to follow the exact instructions that your doctor gives you.

Expert Video - Why is it important to follow bowel prep instructions?

Your doctor will give you the exact diet and bowel prep instructions you need to follow before your colonoscopy procedure. As Dr. Gelrud and Dr. Echavarria explain in this video, it is critically important to follow the bowel prep instructions precisely, so that you achieve a completely cleaned-out colon for a successful colonoscopy. Make sure you fully read the instructions from your doctor ahead of time and that you plan accordingly. The goal of bowel prep is to have a completely clean colon so that your doctor can easily find and remove polyps or other abnormalities. If your bowel prep is not done properly, your doctor may not be able to clearly see inside your colon. As a result, polyps or other abnormalities may be missed, your colonoscopy may take longer than usual, or it is likely that you will have to repeat the whole procedure again. To avoid these scenarios, follow the exact bowel prep instructions for your colonoscopy procedure.

Expert Video - What medical conditions should I tell my doctor about before booking my colonoscopy?

It is very important that you talk with your doctor about any medical conditions you have, before you schedule your colonoscopy. In this video, Dr. Echavarria and Dr. Gelrud discuss some questions you might be asked by your doctor about your medical history, previous medical conditions (such as lung or heart disease), and if you have a history of taking certain kinds of medication, such as narcotics or medications for pain. Your doctor may ask if you are taking antidepressants because these can impact how you are sedated. You may also be asked if you have had any trouble with sedation in the past. Finally, you will be asked if you have had any previous surgeries - especially if you are a woman - because this can make the procedure more difficult.

Expert Video - What medications should I continue or stop taking before a colonoscopy?

In this video, Dr. Gelrud and Dr. Echavarria explain which medications should be continued, which ones should be adjusted in dosage, and which ones should be stopped before your colonoscopy. Be sure to tell your doctor well ahead of your colonoscopy about any regularly prescribed medications you are taking and any health conditions or allergies, as this information needs to be shared when you are booking your procedure. It is very important that you talk about this early and not the day before or the day of your procedure. Some medications may need to be adjusted prior to your colonoscopy, such as insulin, heart medications, or blood thinners. For your individual case, you should ask your doctor if you should continue with, adjust, or stop these medications.

Module: Screening and Diagnosis
Expert Video - Who performs a colonoscopy and what do they look for?

A colonoscopy is a very technical procedure that requires special training in order to be performed effectively and safely. The majority of doctors who perform colonoscopies are gastroenterologists (a doctor whose specialty is the digestive tract), and also well trained surgeons. Any specially trained doctor who performs a colonoscopy, can also be generally referred to as an endoscopist. Drs. Gelrud and Echavarria explain that a colonoscopy involves a thorough examination of the entire colon and rectum to look for problems such as ulcers, inflammation, bleeding, polyps and tumors. If your doctor finds polyps or suspicious areas during the colonoscopy, the polyps will be removed and small tissue samples will be taken (called biopsy) to be checked for signs of cancer.

Expert Video - Who should get a colonoscopy and when?

In this video, Dr. Echavarria and Dr. Gelrud explain who should get a colonoscopy, and when. Routine screening colonoscopy should begin at age 50 in men and women who have normal risk for colon cancer and no symptoms. Colonoscopy should be started earlier if you have symptoms or family history of colon cancer, precancerous polyps, or inflammatory bowel disease. Colonoscopy is also used for other diseases that affect the overall health of the bowel, such as inflammatory bowel disease, diverticulitis, and ulcers. Talk to your doctor about the appropriate time for you to have a colonoscopy. Be sure to discuss any symptoms, family history of colon cancer, or other bowel diseases with your doctor. With this information your doctor can determine if you need to get a colonoscopy earlier, more frequently, or if there are any genetic predispositions that put you at higher risk.

Expert Video - Why is early colon cancer screening important?

Early screening of the colon is one of the most important ways to detect and prevent colon cancer. In this video, Dr. Echavarria and Dr. Gelrud discuss how several studies have shown that by removing polyps, there is a decrease in the number of new cases of colon cancer, and a decrease in colon cancer death rates. Polyp removal is easy and only takes a couple of seconds to a couple of minutes. In contrast, it is very difficult to treat an advanced stage of colon cancer, which could involve surgery, chemotherapy, and the outcome might not be as good as if it had been removed when it was just a small polyp. Recent studies show that if a screening colonoscopy detects colon cancer at an early stage it can be treated with an almost 90% chance of survival. Cancers that are more advanced (i.e., stage IV) only have a 10% survival rate over 5 years. By finding polyps early, there is a better chance of preventing colon cancer. By identifying cancer early, you can improve the outcome of your health and lifespan.

Expert Video - What is a polypectomy?

In this video, Dr. Gelrud and Dr. Echavarria explain that polyps are abnormal growths that can develop in the tissue lining of the colon. Polyps are usually not cancerous, but they can change into cancer over time, and that is why they need to be removed. Polyps found during a colonoscopy are commonly removed by doing a procedure called a polypectomy. Special tools are passed through the scope, allowing the doctor to cut out a polyp and remove it safely. Polyps can be removed using several techniques. A biopsy is a technique that literally bites the polyp mass out and is used on very small polyps. A snare polypectomy is another technique where the polyp is surrounded by a thin wire loop (called a snare) and then an electric current in the wire burns off the polyp from the colon wall. The polyp is then collected for biopsy tissue sample. Some patients worry that a polypectomy may be painful, but Dr. Gelrud and Dr. Echavarria explain that polyps and the colon lining contain no nerves, so you won’t feel pain during removal.

Expert Video - What are the alternative tests to colonoscopy?

Drs. Gelrud and Echavarria discuss alternative tests to colonoscopy that can be used for early screening of colorectal cancer – flexible sigmoidoscopy and CT colonography (also known as virtual colonoscopy). They also talk about at-home stool tests that look for signs of cancer – guaiac-based fecal occult blood test (gFOBT), fecal immunochemical test (FIT) and stool DNA test. The doctors also briefly talk about capsule endoscopy. The doctors emphasize that alternative tests are not a substitute for a regular colonoscopy. If anything unusual is found during an alternative test, you will need a follow-up colonoscopy to confirm the findings. The main advantage of colonoscopy is that it allows your doctor to both visually detect AND remove colon abnormalities during the same procedure. A popular feature of colonoscopy is that it only needs to be repeated every 10 years if the results are normal. Whereas, the alternative tests need to be repeated more frequently even if the results are normal – some every year, others every 3 to 5 years. Regardless which test you use, the most important thing is to get screened for colon cancer. Talk to your doctor about which test is right for you.

Expert Video - What is the difference between a flexible sigmoidoscopy and a colonoscopy?

Colonoscopy and flexible sigmoidoscopy are tests that both screen for colon cancer; however they differ in which areas of the colon they can see. Flexible sigmoidoscopy only examines the rectum and lower third of the colon. Whereas, a colonoscopy examines the rectum and the entire length of the colon. A disadvantage of sigmoidoscopy is that any polyps or abnormalities in the unexamined upper part of the colon will be missed. Another difference is the type of bowel prep that is required beforehand. Flexible sigmoidoscopy requires the patient to do an enema, while a colonoscopy requires full bowel prep. Regardless of which test is performed, good bowel prep is critical for the doctor to be able to see the colon clearly. Talk to your doctor about which test is right for you.

Expert Video - Why is a colonoscopy needed for iron deficiency anemia?

Patients with iron deficiency anemia have low iron levels in their system, and this can be an indication for getting a colonoscopy. As Dr. Gelrud and Dr. Echavarria explain in this video, iron deficiency anemia can sometimes be a sign of underlying colon polyps, or even colon cancer. In addition, irritation in the esophagus, stomach, and duodenum may cause bleeding or oozing that can also lead to iron deficiency anemia. In such cases, your doctor will likely recommend an upper endoscopy as well. Thus, an indication of iron deficiency anemia will often lead to your doctor recommending that you get both a colonoscopy and an upper endoscopy in order to investigate if the cause is internal bleeding or colon cancer.

Module: During and After Colonoscopy
Expert Video - What is a colonoscopy?

A colonoscopy is a medical procedure that allows doctors to look inside the inner lining of the colon and rectum in order to evaluate colon health and look for colon cancer. A colonoscopy helps find problems such as ulcers, inflammation, bleeding, polyps and tumors. The experts explain that colonoscopy is used as an early cancer screening tool in patients who have no symptoms, and in patients who already have symptoms it is used to evaluate and diagnose what the problem might be. Colonoscopy is also used in patients with inflammatory bowel disease (ulcerative colitis and Crohn’s disease) and in patients who have unexplained symptoms such as blood in their stool, to make sure there is no cancer, mucosal disease, polyp, or even tumor.

Expert Video - How is a colonoscopy performed?

This video explains what you can expect during your colonoscopy procedure. The first and most important step before your colonoscopy is to complete your bowel prep, so that your colon is thoroughly cleansed and empty. For the colonoscopy procedure, you will be given a sedative (if desired) so you can relax, and your vital signs will be carefully monitored. You will be placed on your left side on the examining table. Your doctor will start with a rectal examination, and then carefully insert the colonoscope into your anus, rectum, and then guide it through the entire colon. The colonoscope is then slowly pulled back while the doctor carefully examines the lining of your bowel. The last part of the colonoscopy procedure involves retroflexion of the head of the colonoscope in order to examine the rectum prior to exiting. If your doctor finds polyps or suspicious areas during the colonoscopy, the polyps will be removed and small tissue samples will be taken (called biopsy). Once the procedure is completed, you will be taken to rest in a recovery room. The entire procedure should take 15 to 30 minutes, however the amount of time needed may vary from patient to patient, depending on anatomical differences in colon length, ease of moving the scope through the colon, and whether polyps are detected and removed.

Expert Video - What happens after a polyp biopsy?

If a polyp or other abnormality is found during your colonoscopy, it will be removed by a biopsy or polypectomy, and the sample will be sent to a lab for analysis. In this video, Dr. Echavarria and Dr. Gelrud explain that a specially trained doctor (known as a pathologist) will closely examine the sample to check for signs of cancer or pre-cancer. It may take 1-2 weeks to receive the results of the biopsy from your doctor. A benign (non-cancer) result means that your risk of cancer is zero. However, many polyps that get removed do carry a low risk of turning into cancer. If the tissue sample is pre-cancerous you will need to meet with your doctor again. If you had pre-cancerous polyps removed it is good news, since you no longer have those polyps in your body. Patients who have polyps have a higher risk of developing more polyps in the future, so be sure to talk with your doctor about when your repeat colonoscopy should be scheduled.

Expert Video - What can I eat or drink after a colonoscopy?

In this video, Dr. Echavarria and Dr. Gelrud discuss the dietary restrictions that are required after a colonoscopy. You should continue to drink lots of water (about one to two liters) once you are awake and able to tolerate drinking fluids. Most patients will be able to return to a normal, healthy diet after their colonoscopy; however, some patients may need to follow a particular diet if they underwent some sort of procedure during their colonoscopy, such as polypectomy, EMR, etc.