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Colonoscopy is the visual examination of the colon through a tube called a colonoscope . This is an endoscopy , an invasive method of exploration and medical imaging , allowing exploration of the rectum and the entire colon to the ileocecal junction ( small intestine) . The length of the digestive tube is scanned in the order of 1 , 50 m .
Examination of colonoscopy, the exploration and / or intervention in the colon, can be practiced in a diagnostic purpose ( research tumor ) and treatment ( removal of polyps : small growth that develops on mucosa, a benign tumor that can turn into cancer).
Anatomy of the colon
The human colon is a segment of the large intestine between the cecum and the rectum , in the abdominal cavity . This is a muscular organ about 1.5 meters long and 8 inches in diameter . It has three important functions of the body: absorption of food not yet digested , digestion and concentration of feces, storage and disposal of controlled stools. It is not considered a vital organ. In functional terms , the colon is divided into several segments : the right colon ( ascending colon ) and left colon ( descending colon ) separated by the transverse colon . The right colon ( cecum and ascending colon ) plays a major role in the absorption of water and electrolytes , as well as in the fermentation of undigested sugars. The left colon ( descending colon , sigmoid colon and rectum ) is mainly involved in the storage and disposal of feces.
Description of Related Art
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The instrument used is a colonoscope , Olympus here XQ260 variable stiffness video colonoscope .
Position of the patient , device , and the pattern area scanned during a colonoscopy .
The test is conducted most often under anesthesia, after emptying the colon of its feces ( fiber + without bowel preparation regime ) .
The colonoscope is inserted through the anus and slipped gradually into the intestine and directed by the operator using joysticks . It breathes a little air to loosen the walls and move cautiously . The first objective is to arrive at the beginning of the colon ( cecum ) , the limit of the ileocecal valve (junction with the ileum ) . Visualization of colonic walls will be at the phasing of the unit.
The colonoscope is equipped with a light source, an optical system (either optical fibers or by video camera ) , and one or more operators channels . These allow to infuse the air, draw water or wash and especially getting clips for sampling small pieces of mucosa ( biopsy) or use therapeutic instruments ( snare to remove a polyp example). If a polyp is removed, the latter is then recovered for analysis by histology laboratory .
Necessary preparation
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The examination may be conducted under general anesthesia or light sedation ( calming using a sedative) , after emptying the colon of its feces.
For this, the patient must follow a liquid diet 2-4 days before the exam in order to reduce the amount of waste in the intestine.
It must also follow a fiber-free diet ( diet where you have to remove the vegetables , fruits , raw vegetables, fresh bread, etc. . ), Also called "no residue " for 48 hours before the examination. The doctor then prescribed a bowel preparation ( which causes diarrhea ) to drink or swallow tablets so as to remove all fecal matter. These medications should be taken the day before and a few hours before the exam. He may be kind PEG4000 Colopeg yesterday (about ¾ liter diluted or 3-4 liters for other preparations, such Klean Prep ), but there are also tablets to be taken with the liquid that you want (water, light coffee , light tea , soda, fruit juices without pulp, broth filtered vegetables). As effective as PEG , this preparation is often better accepted by patients .
Risk Factors
Observation of deep ulcerations of the sigmoid mucosa associated with Crohn's disease during a colonoscopy.
Colonoscopy is indicated in balances :
personal or family history of cancer ;
family history of familial adenomatous polyposis ;
gastrointestinal bleeding origin ;
chronic diarrhea ;
unexplained abdominal pain.
Indications for colonoscopy
The main indications are :
search for polyps or cancers in the screening of colon cancer ( 17,500 deaths per year in France in 2011) ;
Research the causes of intestinal bleeding ;
Research the causes of unexplained abdominal pain (mostly after 45 years);
Research the causes of chronic diarrhea (lasting several weeks ) ;
monitoring of patients with intestinal diseases clearly identified or known risk factors (cancer, inflammatory bowel disease (IBD) , history of polyps) .
In all these cases , colonoscopy allows to take on the origin of pain, bloating or bleeding. It is also the gold standard for detecting colon cancer .
Rare but important complications : sygmoïdite acute diverticulitis ( a complication of diverticulosis ) with fever for suspicion / risk of perforation or in the immediate myocardial infarction suites.
Incidents and accidents
It is a painless but unpleasant examination , which may limit their use in the absence of general anesthesia.
Complications include :
colonic perforation (less than 0.1 % ) ;
bleeding when biopsy or removal of polyps ( less than 0.5% ) 2, sometimes more than seven days after the procedure ;
diverticulitis : This is an infection of diverticula of the sigmoid colon segment . Diverticula hernias are small intestinal mucosa through the muscular wall of the colon ;
risk of infection ;
explosion colic.
alternative techniques
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Barium enema is a radiographic examination consisting opacify the colon by performing an enema by a radiopaque liquid. The blowing air can better visualize certain anomalies walls (double contrast) . This exam is better tolerated in the delicate subject, but provides less information than colonoscopy. It tends to be replaced by :
The CT colonography (or coloscan ) . Radiological examination is this time replaced by a scanner and only requires air insufflation to open the colonic lumen . It allows a three-dimensional reconstruction of the colon up to a virtual colonoscopy using software aftertreatment increasingly powerful . This review does not allow naturally draw upon the discrepancies.
Virtual colonoscopy . The image of the colon is reconstructed in 2 or 3 dimensions , using a scanner and sending X-rays from different angles.
Digital rectal examination , during this test, the doctor inserts a gloved finger into the cavity rectalt to detect anomalies. It is used from 50 years during routine medical visits , looking for any damage to the prosate or rectum.
Sigmoidoscopy is an examination using a soft, flexible tube , similar to the colonoscope , but shorter. For diagnosqtique test, the doctor may examine the lower part of the colon , a biopsy and remove polyps or detect the presence of tumor. This is a faster but less comprehensive examination that uses a shorter colonoscope and allows exploration of the rectum and sigmoid colon , 60 cm gut .
Current status of colorectal cancer
The colorectal cancer is the second most common cancer in women and the third among men. The number of colorectal cancers expected to increase in France in the coming years to reach 45 000nouveaux annual event in 2020. Approximately 60 % of colorectal cancers affecting the colon and rectum 40% , where the main location is the sigmoid (last part of the colon) . France is among the countries where the risk of colorectal cancer is high, just like other countries in Western Europe , the USA , Australia and most recently Japan. Over the period 2003-2007 , colorectal cancer averaged 8,690 victims each year in men and 7,740 in women. The mortality rate for colorectal cancer decreased by 21 % in 20 years . This favorable trend in mortality resulting from progress in the detection of disease through earlier diagnosis, improved therapeutic management and a decrease in operative mortality .
Colonoscopy in children
Colonoscopy is a visual examination , which serves to highlight discrepancies colon . This technique is essential to determine the origin of digestive symptoms exhibited by the child.
devices
Endoscopes must be adapted to the child's weight . It is therefore necessary to use a suitable pediatric equipment . For explorations of the colon in the newborn and infant, as there is no colonoscope suitable for this age group , a pediatric gastroscope was used. 2 to 12 years , a pediatric colonoscope less than 11 mm diameter are used. After 12 years it is possible to use an adult colonoscope .
bowel preparation
In the days before the test , the child must take medication orally to remove all feces and drink plenty of clear fluids . He must eat nothing and should not drink opaque liquid during this period and until the exam. This allows to avoid reducing the effect of the anesthesia or sedation required to perform the colonoscopy . Be careful : a good bowel preparation is essential. It allows a better consideration and reduces risk.
Anesthesia techniques
Colonoscopy always occurs , regardless of the age of the child under general anesthesia. The pre- anesthesia consultation is mandatory. The examination takes place under the supervision of an anesthetist . Monitoring of the child after sedation, will be performed by trained personnel in pediatrics suitable premises comprising comparable to that used during anesthesia monitoring.
After the examination
Once the child is awake and able to drink , he can go home and start eating normally. Some children may feel sick after the test and should be monitored for some time until they feel better . In the aftermath of the examination, abnormal appearance or persistence of abdominal pain, blood red or black stools , fever or chills, needed to prevent your gastroenterologist, your doctor or the facility where was performed colonoscopy.
indications
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A child may need a colonoscopy for several reasons , including the presence of blood in the stool , diarrhea of unknown cause , abdominal pain may result from intestinal inflammation or monitored from a chronic condition affecting the coating intestines.complications
Complications in children are the same as in adults.
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