Performing an intestinal colonoscopy. Colonoscopy of the rectum

Great importance for each of us has our health. But in order to make sure that the organs and systems are in perfect order, you need to decide on unpleasant procedures and diagnostics. One type of these procedures is a colonoscopy.

If the patient complains of abdominal pain, rectal bleeding, frequent constipation, weight loss, poor blood tests (high ESR, low hemoglobin), in such cases, the coloproctologist prescribes an intestinal diagnosis.

What is a bowel colonoscopy

Colonoscopy is one of the modern methods instrumental diagnostics. It is used to check the pathologies of the rectum and colon.

A colonoscope is a long, flexible device, at the end of which there is a special eyepiece with illumination and a mini video camera.

The set consists of a tube that supplies air to the intestine and forceps, designed to collect histological material.

The video camera is able to take photos of those parts of the intestine through which the umbrella has a passage, and shows a large image on the monitor screen.

With the help of this, the coloproctologist has the opportunity to carefully examine the intestinal mucosa and consider minor pathologies of intestinal changes. The colonoscopy procedure is not a substitute for the diagnosis and treatment of bowel diseases.

One of the main causes of constipation and diarrhea is use of various drugs. To improve bowel function after taking the drugs, you need every day drink a simple remedy ...

Features of colonoscopy

The possibilities listed below make the colonoscopy procedure more important than an informative diagnostic method. It is carried out in many medical institutions. Therefore, the advice of the World Health Organization in the form of prevention should be carried out after 35 years once every five. When a person goes to the doctor with characteristic symptoms diagnostics is mandatory.

Simultaneously during the diagnosis, the doctor has the opportunity to visually assess the condition of the motility of the intestines, colon and rectum, mucous membrane, to identify the inflammatory process.

Make adjustments to the diameter of the intestinal lumen. In case of need, increase the sections of the intestine narrowed by cicatricial changes.

Due to colonoscopy procedures, it is possible to destroy foreign bodies in the intestine or take a piece of tissue for further diagnosis.

If small benign tumors or polyps are found, there is a chance to remove them. The patient does without surgery.

During the diagnosis, there is an option to identify the causes of intestinal bleeding and eliminate them with the help of high temperature.

Video

During the colonoscopy procedure, the specialist takes a picture from inside the surface of the intestine.

Indications for a colonoscopy

The method of colonoscopy for the diagnosis of the intestine is prescribed in such situations:

• If you are worried about pain in the abdomen in the area of ​​​​the large intestine;
• There is discharge from the rectum or pus;
• Bleeding from the rectum;
• Problems of intestinal motility in the form of persistent constipation or diarrhea;
• Overweight, high degree anemia, body temperature within 37.1-38.0°C relatives with cancer;
• Availability foreign body in the intestines;
• Revealing benign tumors or . In these situations, colonoscopy is needed to diagnose the upper colon;

Doctors' contraindications

There are situations in which a colonoscopy procedure is inappropriate, because the procedure will lead to disastrous consequences. Colonoscopy is not performed in such cases:

In such cases, the danger to human health is too high. The Klonoscopy procedure should be replaced by other diagnostic methods.

Preparing for a Colonoscopy

The preparatory process for cleaning the intestines for colonoscopy is done independently. From the level of quality of the preparatory activities, before the procedure, the result will be visible. Read more about preparation.

The doctor will prescribe two things to do before the procedure and to conduct a thorough preparation for the diagnosis:

1. Maintain a slag-free diet.
2. Empty the intestines from feces.

If one of the conditions is not met, the colonoscopy procedure cannot be performed. Preparing the intestines is easy. The following describes each process in detail.

Colon cleansing with an enema:

• The procedure is done three times in the evening before the procedure and in the morning.
• The enema is washed and disinfected.
• The water in the enema should not exceed 36 degrees, cold prohibited.
• The first enema is given at 19:30, the second at 21:00 the day before the procedure.
• The volume of liquid is one and a half liters.
• In parallel with the evening enema, you can use a laxative.
• In the morning at 6:00 - 7:00 am, repeat the enema procedure.

Diet before colonoscopy

A priority place in this cleansing process is occupied by a diet. The slag-free diet is different from other diets.

There is a list of products that must be discarded for the colonoscopy procedure.

These foods include those that can cause gas in the intestines and large stools. Food intake should be stopped 3-4 days before.

Foods that are prohibited before the colonoscopy procedure:

• Various grass;
• oatmeal, millet porridge, barley;
• , carrots, onions, cabbage, turnips, radishes, garlic;
• beans, beans, peas, lentils;
• nuts of all varieties;
• from fruits: tangerines, peach, bananas, apple, pear, grapes, dried fruits;
• berries;
• carbonated drinks;
• all products containing rye flour;
• only dairy products.

Breakfast: One glass, buckwheat porridge, a slice of white bread (you can use butter).

Dinner: Lean beef broth chicken breast, fish (not fatty), a piece of lean meat and rice, a cup of green tea without sugar.

Afternoon snack: A piece of bread, hard cheese.

Dinner: Ryazhenka with a cracker.

On the day of diagnosis, the last meal should be no later than 12:00 noon. At other times, drink unsweetened or plain water. Dinner and afternoon snack should not be consumed. Before the colonoscopy procedure itself, it is forbidden to drink and eat. Water is allowed.

How is a Colonoscopy Procedure Performed?

This type of diagnosis is quite fast and simple. The patient needs to undress from the waist down. Soon to be placed on a firm surface, with a bias on the left side. Bend your legs at the knees and press to your stomach.

After the patient has been prepared for examination, the doctor gradually, carefully and carefully introduces the device directly into the opening of the colon. If the patient has a high level of sensitivity to such procedures, pre-lubricate the anus with petroleum jelly.

Video

The colonoscope moves slowly inside the colon. Her mucous membrane is examined. In order to straighten the intestines, a little air is pumped into them. The procedure lasts approximately 10-15 minutes.

Other diagnostic methods

At modern methods diagnosis, doctors detect many bowel diseases on early stages. Modern doctors offer the following methods for diagnosing intestinal diseases:

• endoscopy;
• Irrigoscopy;
• Magnetic resonance imaging ();
• Ultrasound examination (ultrasound);
• Computed tomography (CT).

The capsule examination is considered minimally invasive. It allows you to examine all parts of the gastrointestinal intestinal tract.

Diagnosis of the intestine using a capsule makes it possible to find cancer of the stomach or intestines.

Intestinal endoscopy is used to diagnose polyps and tumors. Endoscopy is safe and painless method which allows you to analyze the state of the intestine.

The doctor can make a visual result on the condition of the intestinal mucosa.

Irrigoscopy diagnoses the intestines using x-rays. Diagnosis is safe. The level of rays is small.

Magnetic resonance imaging (MRI)- one of the ways to obtain a tomographic medical image for diagnosis internal organs and tissues, using nuclear magnetic resonance.

Ultrasound procedure (ultrasound)- study of the human body using ultrasonic waves.

CT scan (CT)- this is one of best practices modern diagnostics internal organs.

What is better colonoscopy or its analogues?

People say that the colonoscopy procedure is very unpleasant. Therefore, they try to avoid it or ignore it.

The question arises, which is better: a colonoscopy or some of its analogues?

Colonoscopy remains the best quality.

May be assigned CT scan, but it may not be relevant in all cases.

I would like to say that only a specialist gives referrals for colonoscopy procedures based on the tests and the symptom of the patient.

Colonoscopy is an important procedure that can provide comprehensive information about the condition of the patient's intestines.

From the article you will learn in which cases doctors prescribe its passage, as well as the features of its implementation.

A colonoscopy may be ordered different reasons– both after other types of analyzes, and during various symptoms experienced by the patient.

Indications for colonoscopy: blackening of the stool and the presence of blood or mucus in it, severe weight loss in a short period of time, very frequent diarrhea, constant pain in the stomach, feeling of weakness and increased fatigue.

Very often, colonoscopy of the intestine is also done after preliminary studies to make a final diagnosis, for example, if the patient complained that he had a stomach ache.

It is done if polyps or other neoplasms were detected during an X-ray examination - in this case, a colonoscopy will help remove them or determine their nature.

The presence of the patient's next of kin with a diagnosis of colon cancer, as well as if the person experiences symptoms characteristic of this disease, are also indications for colonoscopy.

But in general, the procedure is used to detect absolutely any diseases and pathologies of the intestine.

Colonoscopy is usually preceded by some other examination, such as computed tomography or ultrasound.

Also, the procedure is carried out with deviations detected by blood tests: it may be low hemoglobin, increase in ESR or tumor markers.

With the help of colonoscopy, it is easiest to determine the nature of neoplasms in the intestine, in particular, to distinguish between a tumor and a polyp.

If the latter are found in the stomach or intestines, the doctor will immediately be able to remove them, which is very convenient, since no additional operation is required.

Planned colonoscopies are performed if the patient is at risk.

In addition to close relatives diagnosed with colon cancer, the patient also has ulcerative colitis, has undergone surgery to remove polyps and oncological neoplasms, or is preparing for any gynecological surgery (for example, removal of a uterine tumor) at risk.

How is the procedure?

Many patients, having received a referral for a colonoscopy, worry that it is very painful. However, in reality, this examination does not belong to the category of very complex ones, often bringing only minimal discomfort to the patient.

In addition, if the person is expected to be in actual pain, the physician may opt for an examination under anesthesia.

In a conventional colonoscopy, the patient simply takes a relaxing drug, after which the examination begins.

During the procedure, the patient lies on his side, pulling his knees to his chest, or on his back.

Diagnosis of the state of the intestine is carried out using a colonoscope - this is a narrow, but long and flexible device that can record what is happening inside the body on video.

He makes color pictures of the intestine, so that the doctor can easily and with high accuracy assess the nature of the pathologies found.

The colonoscope is inserted into the intestine through anus the patient, while when the device is inserted into the organ, air is supplied, straightening the intestines, so that the doctor can examine the walls of the organ in much more detail.

It can hurt the patient only at the moments when the colonoscope moves along the bends of the intestines, fixing everything on video, but usually these are weak and short-term pain radiating to the stomach.

A standard study lasts about half an hour, but in some cases, if the doctor has found any neoplasms and pathologies, he can take a biopsy - a small sample of tissue for examination. In this case, the study will take a little longer.

Very often, patients, having learned that they are scheduled for a colonoscopy, want to undergo this procedure under local anesthesia for fear that they will be hurt.

Indeed, there are cases when this examination can be performed under anesthesia. These include intestinal pathologies that can cause severe pain during examination, for example, the presence of large adhesive processes in the abdominal region and destructive ones in the small intestine.

It will also be better to do a colonoscopy under anesthesia if the patient is less than 10 years old.

In other cases, anesthesia is not required, since colonoscopy is not as painful as it is commonly thought. For many patients, anesthesia can often cause a worsening of the condition.

Such patients include people suffering from heart failure and broncho-pulmonary diseases, as well as acute psychiatric or neurological diseases.

Usually, sedative drugs are used as anesthesia for colonoscopy, i.e. local anesthesia - after their administration, the patient is in a state of shallow medical sleep, and the entire examination does not hurt.

However, sedative medications are needed only with a sufficiently intense pain syndrome.

Preparation for the procedure

Colonoscopy requires careful preparation from the patient, otherwise the results will be inaccurate or it will not work at all.

Preparation is carried out in several directions: this is a change in diet, cleansing the intestines and taking special drugs to improve the functioning of the body.

A few days before the examination, foods such as vegetables and fruits, especially unprocessed ones, any carbonated drinks, fatty, very salty or spicy foods, peas, beans and other legumes, black bread, dairy products, mushrooms and berries should be excluded from consumption.

All these products stimulate the process of gas formation in the intestines, which will significantly complicate the procedure.

Instead, you should add low-fat vegetarian soups, boiled poultry meat and fish to your food. low-fat varieties, hard cheese and white bread, as well as broth.

Since the colonoscopy is performed on an empty stomach and usually takes place in the morning, the last meal should be in the evening, and breakfast will have to be skipped.

After you have changed your diet, you should also think about cleansing the intestines - this is no less important for the procedure to be effective.

In order for the study to give a result, the intestines must be cleared of feces, but this must be done immediately on the eve of the colonoscopy, best in the evening.

There are several effective means for cleansing - it is better to consult a doctor before choosing.

For example, some doctors do not advise doing an enema, especially if you have not done it before, because it does not give an effective enough result, besides, the oil that you need to drink beforehand can negatively affect the functioning of the gallbladder.

More effective method- hydrocolonotherapy, which cleanses the intestines much better than an enema.

However, it will be good only if the interval between both procedures is no more than 4 hours.

More modern way preparation for colonoscopy - the use of special drugs to cleanse the intestines.

The experience of doctors shows that saline laxatives are very effective in this matter - they are very easy to use at home, and they show good results without harming the body.

In Russia, 4 types of such drugs are currently widely used: these are Fortrans, Lavacol, Endofalk and Flit.

Fortrans is best known to consumers, as it was the first to appear on the market, but it has an extremely unpleasant taste, and in some it even causes nausea.

More modern drug- Endofalk, it tastes good and is no different from Fortrans in price.

There are more budget Russian analogue laxative - Lavacol, but its effectiveness is lower than that of imported drugs.

Fleet is a little different from all the listed laxatives - it is more concentrated, so the dose that will need to be taken will be noticeably less.

When choosing a method of bowel cleansing, it is better to consult a doctor and decide what will be more effective.

Consequences and contraindications

Colonoscopy is a generally safe test that can be ordered even for children. It does not hurt, so most people are prescribed without anesthesia.

However, in some cases, this method cannot be used: most often this is due to the presence of any serious diseases in a person.

For example, the procedure is very rarely performed on pregnant women, as it can lead to complications.

The only option when a doctor still chooses a colonoscopy is if there are no safer alternatives.

In the presence of Crohn's disease, a colonoscopy can be performed, but not during an exacerbation.

Also, a refusal to study can be obtained if a person has ulcerative colitis or an attack of diverticulitis is observed - in this case, colonoscopy is usually postponed and done after an attack, when remission occurs.

Some injuries or bowel conditions may also be a contraindication to colonoscopy - in this case, doctors try to find a non-contact diagnostic method or prescribe a study only as a last resort, if there are no other alternatives.

In general, the procedure has not many contraindications, so it can usually be performed on almost everyone.

The consequences after a colonoscopy usually appear in cases where the procedure was carried out together with the removal of polyps: in this case, the patient may feel for several days that the temperature is slightly elevated and the stomach hurts.

Very rarely, bleeding can occur after the procedure - sometimes bleeding occurs during a colonoscopy due to vascular damage, but in this case, the doctor can very quickly stop the bleeding.

Other extremely rare consequences of colonoscopy include rupture of the spleen and infection of the patient with the hepatitis C virus.

In some cases, the complication may be caused by the use of anesthesia.

However, practice shows that such severe consequences occur no more often than in 1 case out of 100, provided that the patient is already in a serious condition.

In the vast majority of cases, colonoscopy is extremely effective, because it gives a 100% opportunity to make the correct diagnosis.

The procedure is not as painful as it is commonly believed, so there is no reason to refuse to examine the stomach if the doctor says that a colonoscopy should be done.

Intestinal colonoscopy - special medical manipulation, which is used both with diagnostic and therapeutic purpose. The procedure has a number of contraindications and can be performed under local or general anesthesia. In order for the study to pass without consequences, it is necessary to properly prepare for it.

Colonoscopy is a direct, blind and colon. This makes it possible to diagnose the disease and determine further tactics for managing the patient.

Description of the method

The study is carried out using a colonoscope. It is a thin flexible tube with a camera at the end, which allows you to smoothly pass the bends of the intestine and avoid injury.

As the colonoscope advances, the state of the organ is displayed in multiple magnification on the screen. Thus, a doctor online can examine the intestines for 1.5 meters from the anus.

Indications for carrying out

• pain along the intestines;
• prolonged constipation or diarrhea;
• bloating;
• weight loss;
• the presence of a foreign object;
• secretion of blood, mucus from the anus;
• decrease in hemoglobin for no apparent reason;
• prolonged subfebrile condition.

In addition, the passage of a colonoscopy of the intestine is advisable if you suspect:

• the presence of polyps;
• diverticulosis;
• malignant tumor;
• inflammatory diseases;
• developmental anomalies.

Colonoscopy is performed to determine the prevalence of cancer in malignant lesions of surrounding organs (uterus, prostate, Bladder, stomach).

What does a colonoscopy show?

Checking the intestines with an endoscopic device makes it possible to:

• assess the condition of the mucosa;
• visualize inflammatory foci;
• identify neoplasms, polyps, diverticula, foreign elements in the intestine;
• determine the diameter of the intestine;
• detect areas of cicatricial narrowing;
• visualize ulcerative defects;
• take tissue for biopsy, necessary for carrying out differential diagnosis between a benign process and cancer;
• take pictures that other specialists can watch and evaluate the dynamics of changes in the state of the intestine.

You can learn more about the indications and the algorithm for conducting the study in the video. Submitted by netgemorroya channel. ru.

Contraindications and restrictions

Before undergoing an examination of the intestine, it is necessary to establish the presence of contraindications to the procedure.

Limitations for colonoscopy include:

• infectious diseases of the intestine (salmonellosis);
• severe cardiac and respiratory failure;
• severe hypocoagulation (impaired blood clotting);
• acute ulcerative colitis;
• peritonitis (due to violation of the integrity of the intestinal wall);
• pregnancy;
• severe intestinal bleeding.

For the purpose of early diagnosis of bowel cancer, WHO recommends a colonoscopy once every five years for all people over 40.

Preparing for a colonoscopy

To make a colonoscopy as informative as possible, you need to properly prepare for the diagnosis.

It consists in:

• diet on the eve of the study;
• thorough bowel cleansing.

Diet

3 days before the study, the patient should follow a dietary diet, which includes:

• the exclusion of products that enhance gas formation (legumes, fresh vegetables, muffins, cabbage, mushrooms, carbonated drinks, kvass, berries, oatmeal, pearl barley, dairy products);
• the use of broths, low-fat fish, boiled beef, poultry, semolina, corn porridge, wholemeal white bread;
• complete refusal of food 12 hours before the study.

Purgation

The basic rule of the preparatory period is a thorough cleansing of the intestines, since the presence of feces:

• hinders research;
• makes the diagnostic results inaccurate;
• increases the duration of the procedure;
• increases the risk of complications (intestinal perforation).

There are two ways to cleanse the intestines:

• with the help of enemas;
• by taking laxatives.

With the help of enemas

The enema is performed in the evening on the eve of the study, as well as in the morning on the day of diagnosis (4-6 hours).

There are some nuances of the procedure:

• water for an enema should be 38 degrees (colder - can provoke muscle spasm, and hot - burn the intestinal mucosa);
• the maximum volume of an enema should not exceed 1.5 liters;
• the procedure requires an Esmarch mug (a 2-liter container with a rubber tube and a tip);
• to facilitate the introduction of the tip into the anus, it is recommended to use petroleum jelly or a greasy cream.

The procedure is carried out as follows:

• the couch must be covered with an oilcloth, since there is a risk of leakage of fluid from the anus;
• the patient takes a certain position (on the side with chest knees or knee-elbow);
• Esmarch's mug is filled with warm water;
• air is released from the rubber tube, after which it is pinched;
• the tip is lubricated with petroleum jelly and slowly inserted into the anus to a depth of 8 cm;
• if there is an obstruction in the intestine, you should stop and change the direction of movement of the tip;
• the clamp is removed from the rubber tube;
• water enters the intestines, while the person feels fullness in the stomach;
• at the end of the procedure, the tip is removed from the anus;
• the urge to defecate must be restrained for 5-10 minutes;
• next you should visit the toilet.

In case of insufficient bowel cleansing, it is recommended to repeat the enema after 45 minutes.

Using laxatives

To date, most often for cleansing the intestines before diagnostic procedure laxatives based on macrogol are used. They differ mild action, good efficiency and lack of addiction.

The mechanism of bowel cleansing is:

• an increase in fluid in the intestinal lumen due to a decrease in the rate of its absorption;
• increased hydrostatic pressure;
• irritation of the intestinal walls.

Here are some popular laxatives:

1. Fortrans. The effect occurs 1-1.5 hours after ingestion. Released in powder form. The contents of the package should be dissolved in a liter of water and drunk. Usually, 3-4 packets are required for a complete bowel cleansing. Fortrans should be drunk in the evening and in the morning (no later than 4 hours before the study);
2. Endofalk - is not absorbed into the bloodstream, acts locally. It is produced in powder form. The contents of the package must be dissolved in 500 ml of water. For a thorough bowel cleansing, up to 3.5 liters of laxative is required. It is recommended to drink it in a glass every quarter of an hour.

There is another group of laxatives based on lactulose. They are practically not used to cleanse the intestines before a colonoscopy, but they help overcome constipation.

Their mechanism of action is as follows:

• decrease in pH in the intestine;
• stimulation of peristalsis.

These funds include Dufalac.

As for the use of microclysters (Mikrolaks), in most cases one is not enough to completely cleanse the intestines. So, it is recommended to use 1-2 microclysters the night before and in the morning on the day of the study.

Duphalac - 475 rubles Endofalk - 550 rubles Fortrans - 450 rubles Microlax - 560 rubles

How is the procedure?

Colonoscopy takes place in an endoscopic room. The study can be carried out on an outpatient basis. After talking with the patient, the doctor chooses the method of anesthesia. If sedation is needed or general anesthesia consultation with an anesthesiologist is required.

With or without anesthesia?

The choice of method of anesthesia depends on such factors:

• patient's age;
• the presence of concomitant diseases;
• the purpose of colonoscopy (examination of the intestine or removal of a polyp).

Colonoscopy usually does not cause severe pain in women, unlike men, who have a lower pain threshold.

Colonoscopy can take place:

1. Without general anesthesia using local anesthetics based on lidocaine (Xylocaine, Luan gel). The drug is applied to the anus and colonoscope area, which reduces the severity of pain. In this case, the patient is in a clear mind.
2. With sedation, when the patient is "as if in a fog", while not feeling discomfort and pain. Propofol is used for this purpose.
3. Under general anesthesia. The patient is asleep and does not feel pain. It is worth noting that such anesthesia has its own contraindications, risks and complications.

Often anesthesia is required:

• children;
• with a pronounced adhesive process;
• patients with mental disorders;
• people with a low pain threshold.

The success of a colonoscopy largely depends on the emotional state of the patient. Panic complicates the research process and increases the risk of diagnostic complications.

Technique and duration of colonoscopy

The duration of the study is 10-25 minutes.

Time depends on:

• the purpose of the colonoscopy;
• careful preparation for diagnosis;
• physician qualifications.

Methodology and order of examination:

• the patient is located on the couch with a disposable diaper;
• takes the position "on the left side" and presses the knees to the chest;
• the anus is treated with an antiseptic solution, then with a lubricant (to facilitate the insertion of the colonoscope into the anus);
• the colonoscope moves along the intestine, in parallel forcing air into the intestine;
• the doctor controls the movement of the colonoscope with his hand through the anterior abdominal wall;
• after examining the bowel, the colonoscope is slowly removed.

Complications and side effects

After the study, the patient may still feel bloating and discomfort in the abdomen for some time, which is associated with the presence of air in the intestines.

Complications are observed in 1-3% of cases and are represented by such problems:

• perforation of the intestinal wall with the ingress of feces into the abdominal cavity and the development of peritonitis;
• bleeding;
• pain that occurs after the removal of polyps;
• undesirable effects of anesthesia (hypotension, respiratory failure).

If the patient has blood in the stool, weakness, abdominal pain and hyperthermia after the procedure, you should consult a doctor.

Survey results

The interpretation of the results is carried out exclusively by a specialist who evaluates:

• mucosal color;
• the presence of a tissue defect;
• shine;
• the nature of the surface;
• the amount of mucus;
• vascular pattern;
• the presence of additional education.

The conclusion may include:

• normal picture;
• polyps;
• tumor;
• ulcerative lesions of the mucosa;
• intestinal tuberculosis;
• diverticulosis.

Norm

The normal picture of the state of the intestine is presented:

• pale pink color of the mucosa;
• shine, which indicates a sufficient amount of mucus produced;
• smooth, slightly striated surface;
• uniform vascular pattern without foci of enhancement and absence of blood vessels;
• small accumulations of clear mucus.

polyps

Due to a violation of the process of renewal of the intestinal mucosa, outgrowths, the so-called polyps, can form. They can be with a wide base or a thin leg. Polyps are not accompanied by severe symptoms, however, with prolonged inflammation, they can become malignant, that is, degenerate into cancer.

Diseases of the large intestine are most often accompanied by defecation disorders (passage or constipation), bloating, mucus or blood in the stool. Most patients are embarrassed to talk about these problems to the doctor. However, the frequency of oncological lesions of the large intestine is steadily increasing. Most often, the problem is detected already in the late, untreatable stages. For early diagnosis of intestinal pathologies, an endoscopic colonoscopy method is used, which allows you to assess the structure and functioning of the organ, as well as carry out minor medical manipulations.

What is the study

Colonoscope - a device for conducting research (photo: www.tehnopark-service.narod.ru)

Colonoscopy (from "colon" - large intestine, "scopeo" - to examine) is a method for diagnosing diseases of the intestine using a colonoscope.

A colonoscope is an endoscopic fiber optic device, which is a long flexible tube. Inside the device there are about 3000 thin glass fibers through which light enters the area under study. On the monitor screen or in the eyepiece - an image. The instrument is inserted into the intestinal lumen through the anus, the area from the otkhodnik to the final section of the small intestine is examined.

The flexibility of the instrument allows manipulations with rotation for a more detailed examination of the area of ​​interest. In addition, there are two additional channels:

• For supply and intake of air or liquid. Inflating the intestinal loops allows you to increase the field of view or detect changes in areas hidden by folds.
• Working channel through which instruments are passed. During the study, a biopsy is often taken (taking a piece of tissue for laboratory analysis) with special forceps, or stops bleeding with a coagulator.

The study is carried out by an endoscopist in a specially equipped office of a hospital or clinic. The duration of the procedure is from 10 to 60 minutes, depending on the need for medical manipulations.

Indications for a colonoscopy

The appointment of the study is carried out in the presence of symptoms of damage to the large intestine: blood in the stool, pain in the lower abdomen, diarrhea, violations of the act of defecation or to confirm the diagnosis established by other methods (computed tomography or ultrasound). The procedure is indicated for such diseases:

• Nonspecific ulcerative colitis or Crohn's disease - inflammatory diseases large intestine, accompanied by a violation of the integrity of the wall, the occurrence of superficial and deep ulcers. These pathologies are common cause the appearance of blood in the stool.
• Intestinal polyps - benign neoplasms from the mucous membrane, which outwardly resemble a mushroom: a thick head on a thin stalk. Most often, there is a genetic predisposition to the appearance of polyps (familial polyposis).
• Colon cancer is a malignant lesion of an organ, which can be in the form of a tumor that blocks the movement of feces and causes constipation. Another option is a deep ulcer, which is often the source of intestinal bleeding.
• Diverticula - pathological protrusions of the intestinal wall, often occur in the elderly due to muscle weakness.

In addition, the method is used to diagnose congenital anomalies in the development of the intestine, stop small bleeding and remove benign tumors.

The incidence of cancer increases in people over 50 years of age. At a young age, inflammatory pathologies are more often detected.

Doctor's advice. For people who have no complaints, a colonoscopy is recommended at age 50 and every 10 years thereafter. The frequency of the procedure for people with a burdened history is determined by the attending physician

Contraindications for the study

The procedure is associated with the filling of the intestine with air and an increase in intra-abdominal pressure, which limits the possibility of conducting a study. The colonoscopy procedure is contraindicated in such cases:

• Presence of symptoms acute abdomen: acute cutting pain and muscle tension in the affected area, positive symptoms of peritoneal irritation. Most of the time, these symptoms are acute appendicitis, cholecystitis or perforation (breakthrough of a hole in a hollow organ) ulcers.
• In the early postoperative period after organ intervention abdominal cavity and small pelvis.
• In the presence of a hernia: an increase in pressure within the intestinal lumen can cause the protrusion to be incarcerated. This state is an indication for emergency surgery.
• Decompensated diseases of the cardiovascular and respiratory systems.
• Pregnancy at all times.
• Bowel perforation transferred within the last 6 months.

In addition, the study should be postponed in patients who feel cramping pain or severe abdominal discomfort on the day of the colonoscopy.

Study preparation

Before a colonoscopy, tell your doctor about all medications you are taking. This is especially true for patients who use drugs that affect blood clotting (Aspirin, Warfarin).

Important! Dose adjustment and withdrawal of the drug is carried out only after consultation with the attending physician.

Patients who have an artificial heart valve are given antibiotics for 3 days before the procedure.

Good visualization of the intestinal walls is possible only after its complete cleansing. For this, the patient is recommended the day before the study:

• Drink at least 1.5 liters of water or a special cleaning solution.
• Taking laxatives (for example, Dufalac).
• 3-4 hours before the procedure - a cleansing enema.

The objectivity and information content of the study depends on the implementation of the recommendation. In case of insufficient visualization of the walls of the colon (for example, in the presence of residual feces in the lumen), the procedure is terminated and a date for re-conduct is assigned.

How is a colonoscopy performed?

The study may be accompanied unpleasant sensations: abdominal pressure, pain, spasms. Therefore, before the procedure, patients are intravenously injected with sedatives (sedatives) that reduce pain and relax the tense muscles of the anus. In addition, when a feeling of fullness in the abdomen appears, the patient is advised to take a deep breath, which relieves the tension of the intestinal muscles.

During the study, the patient takes off his clothes and lies on his left side. The end of the colonoscope is lubricated with petroleum jelly or glycerin for easy passage through the anus. The device is gradually advanced to the lumen of the caecum or the final part of the small intestine.

Analysis of the state of the intestine is carried out during the reverse movement of the colonoscope. The doctor evaluates the color, relief and integrity of the wall, the presence of formations. To increase the field of view through an additional channel, not a large number of air to loosen wrinkles. If a suspicious area is found, a tissue sample is taken for examination (biopsy).

Therapeutic colonoscopy involves the introduction of special tools to remove polyps and stop bleeding from small vessels. In case of unsatisfactory visualization of the intestine, the doctor decides on the need for a second study.

The average duration of the study is from 10 to 60 minutes.

Advantages of the method

After being introduced into clinical practice colonoscopy has significantly increased the number of patients who decided to study the colon. Choice this method due to high information content and safety.

Comparative characteristics of colonoscopy and the previously used barium enema X-ray examination are shown in the table.

In addition, the method is the "gold standard" for diagnosing diseases of the large intestine, since it allows for therapeutic manipulations and sampling of material for histological examination.

Possible complications after the procedure

After a colonoscopy, undesirable consequences occur extremely rarely. Possible complications include:

• Bleeding that occurs at the site of a biopsy or polyp removal. Most often, blood loss is insignificant and is prone to self-destruction due to the formation blood clots that clog the vessel.
• Perforation (perforation) of the intestine. The condition occurs due to rough advancement of the colonoscope or thinning of the intestinal wall. This condition occurs less frequently than bleeding and is treated without surgery.
• Allergic reaction on the drugs used: localized (redness and swelling at the injection site) and generalized (with damage to the general blood flow). The frequency of occurrence is less than 1%.

Although undesirable consequences of colonoscopy are rare, it is necessary to determine early signs complications for timely provision emergency care. In case of fever, chills, severe abdominal pain or massive bleeding from the anus, the colonoscopist must stop the study.

How to interpret colonoscopy results

The study involves not only treatment, but also the final diagnosis of pathologies of the large intestine with a biopsy. During the procedure, the doctor evaluates the length and lumen of the final section of the digestive tract, the color of the mucous membrane and its structure, the presence of neoplasms, indicating the shape and size. If a suspicious area is found, material is taken for laboratory analysis.

Normally, the mucous membrane of the large intestine is pale pink, smooth and shiny. The diameter and shape of the intestinal lumen varies in different sections (for example, in the transverse rim - 3-coal, due to the muscle layer, represented by bundles of ribbons). In the lower parts of the rectum, the mucous membrane acquires a fine-grained surface due to the large number of lymphatic follicles in the wall of the organ.

Changes that are characteristic of individual pathologies are presented in the table.

In case of insufficient information content of the study, the doctor decides on further diagnostic tactics. It is possible to repeat colonoscopy without prior preparation or use video capsule endoscopy to assess the state of the digestive tract from the esophagus to the rectum.

The video below shows the research technique.

Today, medical diagnostics has in its arsenal a large number of methods that allow correctly assessing the patient's condition and identifying the development of life-threatening pathologies at an early stage. One of them is the study of the inner walls of the colon using instrumental equipment: colonoscopy is performed in cases where it is necessary to visually assess the condition of the intestinal tract and biopsy the affected tissues.

What is the procedure for?

The essence of colonoscopy is extremely simple. For its implementation, optical instrument(colonoscope, hence the name). Its body is a hollow flexible tube. At one end, a backlight and a miniature video camera are fixed.

The image is transmitted in real time to the monitor, so the doctor has the opportunity to see the condition of the inner walls of the colon over a distance of two meters, evaluate the luster of the mucosa, its color, study the vessels located under it, and changes caused by the inflammatory process.

One sachet of "Lavacol" dissolves in 200 ml of water. For a complete cleansing, you need to drink three liters. The taste of the powder is more pleasant, so its reception is easier to tolerate. Doctors recommend taking "Levacol" in the afternoon until 19.00.

The tools described here have been specifically designed to prepare you for colonoscopy examinations. They gently cleanse, but in many patients they cause adverse reactions in the form of flatulence allergic manifestations and discomfort in the abdomen. The child will not be able to drink the required dose, so no one writes off the enema yet.

How is a colonoscopy performed?

Many, going to diagnostic examinations, want to know how they are carried out. Having a complete understanding of the process itself, it is easier to tune in correctly and go through the procedure painlessly.

1. So, first, the patient is asked to lie down on the couch and turn on his left side, pulling his knees to his stomach.
2. Then the diagnostician treats the anus with an antiseptic and gently inserts the probe into it. Anesthesia is not used if the person is highly sensitive and complains of being in pain during the insertion of the endoscopic equipment, anesthetic gels may be used. Sedation is also practiced, but it significantly increases the price. diagnostic examination. Severe pain occurs only if you need to do a colonoscopy in a patient who is suspected of acute inflammatory processes or there are adhesions in the rectum. In this case, make a short general anesthesia(for 30 minutes).
3. After anesthesia, the doctor gently inserts the probe into the anus, moves it slowly deep into the intestine. In order to straighten the folds of the tract and more carefully examine its mucosa, air is pumped through the pipe.
4. The probe can move 2 meters deep into the intestine, all this time the camera will show the internal state of the hollow organ. If the probe's path is not found pathological changes, colonoscopy is done for about 15 minutes. If necessary, perform therapeutic actions, as patients' reviews show, it may take more time.
5. For tissue sampling histological analysis anesthetics are injected through the endoscope tube local action, then a small piece of diseased tissue is removed with forceps and taken out.

Colonoscopy is used to remove polyps, small single neoplasms. For these purposes, not tongs are used, but a special device similar to a loop. With her, like a lasso, the doctor grabs the convex part of the outgrowth at the base, pulls it, cuts it off and removes it.

Before the advent of the colonoscope, resection was possible through laparoscopy, although this is a minimally invasive operation, it requires a more complex preparatory process and recovery.

Video: Colonoscopy of the Intestine

Rare Complications

When the examination ends, the doctor must perform certain manipulations: with the help of a probe, he pumps air out of the intestine and gradually removes the instrument. After this, many patients experience a feeling of strong distension of the abdomen. Pills help get rid of it. activated carbon.

In the event that the described procedure is carried out in a specialized institution, and it is trusted by an experienced doctor, the risk of complications is minimized. But he still exists. What to beware of:

• Perforation of the intestinal wall. A complication occurs when a colonoscopy can identify and show mucosal manifestations accompanied by purulent processes. The patient is immediately taken to the operating room and the damaged area is surgically restored.
• Bleeding. This occurs after the removal of polyps and neoplasms. Eliminated immediately by cauterization of the site and the introduction of adrenaline.
• severe pain in a stomach. Appear after biopsy. The malaise is eliminated by taking analgesics.
• Fever, nausea, vomiting, bloody diarrhea. Such side effects are extremely rare, but if at least one symptom appears, you should immediately seek medical help.

Contraindications

There are conditions in which it is not possible to examine a patient with a colonoscope. It:

• Acute infections in the body.
• Diseases of the cardiovascular system.
• Pressure drop.
• Pulmonary insufficiency.
• The presence of violations of the integrity of the intestinal tract (perforation with the release of contents into the peritoneum).
• Peritonitis.
• Ulcerative colitis accompanied by inflammation.
• Massive bleeding.
• Pregnancy.
• Poor blood clotting.

There are no indications for colonoscopy in infants. If it is impossible to use the described method, other methods of diagnosing diseases of the lower colon are selected.

Video: Colonoscopy - answers to questions

Alternative to the procedure

There is only one examination in the arsenal of physicians that can compete with the described method in terms of information content. This is an MRI of the intestines. Doctors call each other this species virtual colonoscopy examinations. Anyone who has ever gone through the procedure notes that it feels more comfortable, experts pay attention to the sparing nature of the diagnosis.

It is performed using equipment that allows you to scan and take pictures of the abdominal cavity from different sides, and then create a three-dimensional model of the intestinal tract. All pathological processes are clearly visible on it, while the patient does not experience any discomfort.

Why do doctors still use a colonoscope? The fact is that MRI does not allow to show pathological neoplasms, the diameter of which does not exceed 10 mm. Therefore, magnetic resonance imaging forms a preliminary conclusion, and after it, when the doctor wants to clarify the diagnosis, he prescribes an instrumental examination.