Che Miller, M.D.

Patient Education Literature
We recommend that you read this handout carefully in order to prepare yourself or family members for the procedure.  In doing so, you will benefit both the outcome and safety of the procedure.  If you still have any questions or concerns, we strongly encourage you to contact our office prior to your procedure so that we may clarify any pertinent issues.
Colonoscopy
Definition:
This procedure involves inspecting the colon with a flexible camera.

Purpose of the procedure:
There are several reasons this procedure is performed.  Most commonly the colon is inspected to evaluate for cancer or pre-cancer polyps.  However, it may also be performed to look for inflammation, bleeding, ulcers, or diverticular disease.

Preparation:
As with any procedure, you will be asked not to eat or drink anything after midnight on the evening prior to your procedure.  The procedure involves a full bowel preparation the day before the procedure with a solution that will stimulate clear diarrhea.  This is routine so that the surgeon can see the wall of the colon and not have the camera view obstructed by stool.  You will receive a separate form that will give you instructions for the bowel prep.  These instructions should be followed to the letter or the procedure may be unsatisfactory and have to be repeated later or a less accurate alternative chosen in its place. You may brush your teeth in the morning, but do not swallow the water.  If you are on medications that must be taken you need to discuss these with the surgeon.  Aspirin products, blood thinners, arthritis medications, insulin, and iron preparations are examples of medications that may require special instructions.

Description of Procedure:
On the day the exam, you will be evaluated by several hospital staff.  An IV will be started and you will be taken to the endoscopy suite.  There, you will be given some sedation and asked to turn onto your left side.  The sedation will not make you go to sleep all the way but should make you very relaxed.  Most patients never recall the procedure.  A colonoscope will be placed through the anus and into the colon.  It will be advanced until the whole colon has been seen.  Air will be injected in the colon to help the surgeon get a better view.  If an area needs to be better evaluated a forceps is passed through the scope and a biopsy is obtained and is submitted to pathology for a microscopic exam. If the exam is performed because of bleeding, the site can be identified, sample of tissue obtained, and the bleeding controlled by several means. Should there be polyps (benign growths that can lead to cancer) sometimes they can be removed through the colonoscope. Removal of these polyps is an important method of preventing colorectal cancer. None of these additional procedures typically produce pain. After the study you will be taken to the recovery room where you will waken fully.  

After the procedure:
Following the procedure, you will awaken in the recovery room.  It is not unusual to feel confused or out of place.  Fluid intake is important.  Patients will be kept in an observation area for an hour or two, until any medication given adequately wears off. Your reflexes and judgment may be impaired for the rest of the day, making it unsafe to drive or operate any machinery. Should patients have some cramping or bloating this should be relieved quickly with the passage of gas.  There should be no restrictions to your diet or activity. You may experience some diarrhea for a couple of days after your study.  Blood may also be found in your stools for a couple of days.  This is normal and you should not be alarmed.  This should return to normal by one week.  If it does not, contact your surgeon.  You may do anything that is comfortable. You may lift anything, you may exercise as you desire. You may have intercourse, and you may swim. 
 
Risks, Benefits and Alternative Procedures:
Colonoscopy complications are rare and usually minor when performed by physicians who have been specially trained in these endoscopic procedures.  Bleeding may occur at the site of biopsy or polypectomy, is usually minor and self-limited.  It is quite unusual to require transfusions or surgery. An even less common complication is a perforation or a tear through the bowel wall that could require surgery. Other potential complications are reaction to the sedatives used, localized irritation to the vein where medications were injected, or complications from heart or lung disease. Hot towels or moist packs often help relieve the discomfort of an irritated vein. The incidence of all of these, together, is less than one percent. Colonoscopy is the best test available to detect and treat abnormalities within the colon. The alternatives to colonoscopy are quite limited. Barium enema is a less accurate test performed with x-ray. It misses lesions more often than a colonoscopy.  At times, an abnormality or lesion detected with a barium enema is actually stool or residual food in a poorly cleansed colon. Colonoscopy may then be necessary to clarify the issue.

Conditions to Look For: 
Although colonoscopy is remarkably safe, problems can arise. Should any of the following occur, please contact your physician as soon as possible:
1. Fever greater than 101 degrees.
2. Persistent vomiting after the third postoperative day.
3. Failure to have a bowel movement after four days.
4. Persistent abdominal distention and tenderness.

Emergencies:
The following is a list of emergencies.  Should any of these develop, proceed to your emergency department.  If you feel that you cannot make it to your emergency department or do not have someone to take you, call 911 immediately.
1)	Weakness or lightheadedness that prevent you from being able to walk.
2)	Chest pain or shortness of breath.
3)	Uncontrollable vomiting.
4)	Rectal Bleeding more than  of a cup.
Follow-up 
You should see your surgeon for a office visit approximately one week. Please do not hesitate to contact your doctor at anytime if things do not appear to be going smoothly.  Occasionally, if your colonoscopy is normal, your surgeon my contact you by phone and no office visit is necessary
Consent for Procedure:
I _______________________ have read the above description of my procedure.  I understand the indications, risks and benefits of surgery listed on this form and explained by my surgeon.  I agree to undergo a colonoscopy, biopsy, and any other indicated procedures.  I have had an opportunity to ask questions and have received all the information I need to make this decision.




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Patient Signature:				Surgeon Signature				Date