This ASG video tip is sponsored by Braintree, maker of the newly approved Suflav and Sutab. So a great procedure before actually proceeding with a colonoscopy, it's important to consider the patient's indications for the procedure, their symptoms, whether the procedure is appropriate for the patient, and also what kind of, what time frame are we trying to perform that procedure in. So timely scheduling is important, you want to consider does the patient have acute or urgent symptoms such as bleeding, weight loss, these are considered alarm symptoms, or are they presenting for evaluation of more chronic symptoms such as chronic diarrhea. A lot of patients will present complaining with lifelong symptoms and the urgency with which that colonoscopy may need to be done, you know, may be okay for a few weeks down the road, whereas some of the more urgent symptoms you might want to bring in within the next week or two to do their evaluation. So time, it's important to consider the timeliness of that scheduling for the procedure depending on the indication. Patient selection itself, so when a patient's presenting, will doing a colonoscopy actually affect the management of that patient, what do you anticipate potentially finding at the time of a colonoscopy that's going to affect the way you approach your management. Have you considered empiric treatment ahead of time, if they have symptoms that make you concerned most prominently for Irritable Bowel Syndrome, might you try a trial of fiber probiotics before considering a colonoscopy, particularly if there's no alarm symptoms right away. If they failed empiric treatment, then that would be potentially an indication to proceed with the procedure as initially planned. Do you anticipate any therapeutic interventions, so if they have a history of polyps or large polyps, do you anticipate needing a resection, endoscopic resection during the procedure. If they're presenting with rectal bleeding and they have a history of radiation to the prostate for prostate cancer, might you anticipate encountering radiation proctitis and anticipate needing to provide coagulation therapy during that procedure. If they have a history of bowel resection and they're presenting with symptoms that make you concerned about the possibility of a stretcher, might you anticipate a dilation. So it's important to anticipate based off of the history and the symptoms, what kinds of therapeutic interventions might be encountered or necessary during that colonoscopy. And colonoscopy can serve as an alternative for radiology, it's important to think that, to understand that CT scan can provide a lot of information, a lot of detail for many of the symptoms that patients will present with, but many times there are smaller things that the CT scan may not be able to pick up on. Even the coastal changes related to inflammatory bowel disease, early changes may not be picked up on CT scan and you're more likely to find those changes on a colonoscopy. So again, thinking about the indications, are they presenting for a screening or surveillance procedure? Are they presenting with actual symptoms such as bleeding or weight loss, anemia? And do they have, what's their pre-procedure testing has shown? Do they have abnormal imaging? Do they have an abnormality on the CT scan that needs a close examination? Or are you anticipating the need for diagnostics or therapeutic interventions during the colonoscopy? It's also important to consider what are the potential contraindications for the patient. So it's important to assess against the benefits of the colonoscopy versus the risks. If somebody has multiple comorbidities, they're on antiplatelet therapy or anticoagulation, are they acutely ill with electrolyte abnormalities? Are you seeing this patient as an inpatient? It's important to consider what are the risks of the whole process, risks of the procedure itself, but also the risks of sedation, risks of anesthesia, risks of bowel preparation for those patients. The patients that you're not able to get consent for, if it's not an emergency procedure, what is the process to obtaining consent for those patients in finding the appropriate healthcare surrogate or power of attorney? If a patient has a known perforation or a suspected perforation, that would be a contraindication to insufflating air and spit pollen to perform a colonoscopy. In the presence of fulminant colitis, such as severe ulcerative colitis or C. difficile colitis, the risks of colonoscopy would significantly outweigh the benefits of that exam. Again, in the setting of acute electrolyte abnormalities, the risks of the procedure, risks of sedation, risks of bowel prep all need to be considered. Thank you.

colonoscopy

patient symptoms

acute symptoms

chronic issues

therapeutic interventions