ASGE Annual GI Advanced Practice Provider Course - Day Two | July 2021-16_Colonoscopy the Basics

16_Colonoscopy the Basics - Vicari

Pdf Summary

Colonoscopy is a procedure used to examine the colon for any abnormalities or diseases. The process can be divided into three phases: pre-procedure, intra-procedure, and post-procedure. In the pre-procedure phase, timely scheduling and appropriate patient selection are important. The procedure may be indicated for screening or surveillance of colon cancer/polyps, lower gastrointestinal bleeding or symptoms, abnormal imaging, inflammatory bowel disease, or therapeutic intervention. Patients should follow specific preparations such as clear liquids and a low residue diet, and avoid certain medications like anticoagulants. Sedation assessment is also crucial, considering factors such as prior sedation difficulty, narcotic/benzodiazepine use, anxiety, and increased risk for airway or cardiopulmonary complications.<br /><br />During the intra-procedure phase, different types of colonoscopes are used depending on the patient's age and body habitus. Various devices like forceps, snares, baskets, and hemostatic clips are utilized for tissue sampling, polypectomy, tattooing, and endoscopic hemostasis. Additional diagnostic and therapeutic maneuvers may include dilation of strictures, stent placement, endoscopic mucosal resection, and placement of a colonic decompression tube. Complications during the procedure are relatively low, with cardiopulmonary complications related to sedation being the most common. Proper anesthesia risk assessment, management of high-risk patients by anesthesia services, and appropriate monitoring can help reduce these risks.<br /><br />In the post-procedure phase, participating in quality data base projects, monitoring adenoma detection rates, achieving a high cecal intubation rate, and managing post polypectomy bleeding and perforation are important indicators of quality. Post polypectomy bleeding typically occurs 5-7 days after the procedure, while perforation rates are low. Other complications that may arise post-procedure include post polypectomy syndrome, infections, and the need for follow-up. It is essential to consider these phases of colonoscopy, carefully select patients for the procedure and sedation, and be aware of potential complications in order to ensure optimal outcomes.

Keywords

colonoscopy

procedure

abnormalities

pre-procedure

intra-procedure

post-procedure

screening

polyps

complications

sedation