Colonoscopy and Enteroscopy

It is recommended that a preventive colonoscopy is performed every 10 years for patients aged 55 and over. If there is a history of bowel cancer in the family, colonoscopies are advised from the age of 40. To be more specific, it is recommended to start examining the patient 10 years earlier than the condition occurred in the relative. Other risk factors are diseases (such as colitis ulcerosa) that increases the risk of bowel cancer .

Colonoscopies are conducted by gastroenterologists. Gastroenterology is a discipline of internal medicine. The gastroenterologist is additionally trained to do colonoscopies, and is required to conduct a certain number of colonoscopies each year. The colonoscopy is either performed in a doctor‘s office or at hospital; a longer stay is only rarely necessary.

Why do a colonoscopy? Reasons for a colonoscopy are prevention, to clarify unspecific symptoms, procedure-aftercare, or for diseases such as cancer.

A colonoscopy is used to diagnose bowel cancer – which is why people over 55 years are entitled to colonoscopies paid for by their health insurance even without showing any symptoms. They also find diverticula and diverticulitis, chronic inflammation diseases such as Crohn‘s disease and acutely inflamed diseases or circulatory disorders of the intestinal wall.

The following symptoms might indicate the necessity of a colonoscopy: fecal blood, rectal bleeding, tarry stools (a colonoscopy might be necessary if a gastroscopy was inconclusive), sudden weight loss, loss of appetite, findings of metastases without detection of the primary tumour, atypical changes in the bowel movement such as congestion or diarrhoea, as well as unspecific pain in the middle or lower stomach.

Before doing a colonoscopy, the doctor will check eating habits and medical history to assertain the possibility of healing the symptoms by changing habits, or whether a disease is likely to have afflicted the patient. Additionally, alternative diagnostic methods can be used.

It is important to keep in mind that if the patient suffers bowel occlusion , acute diverticulitis or peritonitis – a colonoscopy must not be conducted.

How is it done? Preparation starts about seven days before the colonoscopy, since the patient has to keep a strict diet and avoid certain food. The day before the colonoscopy the patient may only eat solid meals until lunch-time and then has to take laxatives to empty the intestinal tract. Afterwards, only liquid food is permitted. This provides a clear image during the colonoscopy.

It is highly important to inform the doctor about medication that the patient is taking since laxatives might impair their function.

For the colonoscopy, the doctor inserts the flexible colonoscope equipped with a camera through the anus and the rectum into the colon. The patient lies in a lateral position. Before inserting the colonoscope (a flexible tube with a diameter of about 1 cm and a length of about 1.2 metres) it is covered in lubricant. Air is also pumped into the intestine, widening it and causing the mucous membranes to unfold. Fecal remains can be removed with the colonoscope. The image is transmitted onto a screen. This also gives the patient the opportunity to observe the examination. If tissue samples are extracted or ulcers need to be removed, the required instruments are inserted via the working channels of the colonoscope.

The whole procedure normally takes about thirty minutes, however, extraction of tissue samples or the immediate removal of growths takes more time.

Which risks does a colonoscopy bear? Overall, colonoscopies rarely have complications, however, haemorrhages might occur. Very rarely the intestinal wall is broken by the colonoscope. More often, the patient reacts badly to anesthesia.

How is an enteroscopy conducted? As an alternative to inserting an endoscope into the small intestine , doctors use the capsule endoscopy. The patient swallows a small pill containing a camera, a light and a transmitter. Over the following eight hours the capsule finds its way through the entire digestive tract and takes about 60,000 pictures. To provide an unimpaired vision onto the mucosae, during the enteroscopy patients are only allowed to consume clear fluids. As soon as the capsule reaches the colon the patient may take in solid meals again. The capsule is afterwards excreted.

EXERCISE: 1. Why is colonoscopy done?

a) as a reason of precaution b) to diagnose bowel cancer c) discovering diverticula d) in patients over the year of 35 e) in case of heartburn

2. One risk of colonoscopy can be haemorrhage.

a) True b) False

3. Endoscopy is conducted by a capsule.

a) True b) False

You’ll find the answer on the next page.

BIBLIOGRAPHY http://dict.leo.org. Koop I.: Gastroenterologie compact, Thieme Verlag 2013. www.dict.cc. www.mayoclinic.org. Waye J.D., Aisenberg J., Rubin P.H.: Practical Colonoscopy, Wiley Blackwell, 2013. www.webster-dictionary.org. CARMEN LOBITZ Carmen Lobitz ist freie Trainerin, Lehrerin und MTA. Sie gründete 1998 in Berlin lobitz seminare, die unter anderem Englischseminare für Health Professionals anbieten. Kontakt: mail@lobitz-seminare.de www.lobitz-seminare.de

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Lösung für Exercise: 1. A + C + D 2. A 3. A

Colonoscopy and Enteroscopy

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