Common Procedures

Colonoscopies may be performed:
1. To assess people without symptoms but are thought to be at risk of cancer. This is called screening.
2. To assess people who aren’t showing symptoms but who have a high risk for cancer (positive family history or previous polyps). This is called surveillance.
3. To follow up patients with cancer or other bowel conditions (e.g. crohns disease or ulcerative colitis),
4. To assess signs and symptoms that could suggest cancer or other serious conditions
Bleeding from the bowel
• Blood, pus or mucus in the faeces
• Unexplained abdominal pain
• Changes in bowel habits such as long-lasting diarrhoea or constipation
• Unexplained weight loss

How often should I have a Colonoscopy?

Your doctor is the best person to determine how often you should have a colonoscopy.
Important determining factors include:

current research and clinical guidelines
your age
any family history
the age your first degree relative (parent or sibling) was diagnosed with colorectal cancer
findings from your previous colonoscopies (e.g. number and type of polyps)
your health problems (increased risk of colorectal cancer in ulcerative colitis patients)
your risk of having the procedure (largely determined by your medical history).

Your doctor has to weigh up these and other factors; however the most important person in the decision is you. Be part of the process. Ask questions and make sure you understand what the plan is.

Who performs a Colonoscopy and Where?

A colonoscopist is usually a gastroenterologist or gut surgeon. All colonoscopies are performed in hospital with most being performed in private hospitals as same day procedures.

How is a Colonoscopy performed?

The colonoscope is a long flexible tube with a small video camera and light at the end. When passed through the anus, the colonoscope allows the doctor to get an inside look at your colon and rectum. The colonoscope also has a channel which allows cutting and cauterising instruments to reach its tip. Polyps or cancers can be viewed up close, removed or biopsied.

The colonoscope is about as thick as your finger and can be carefully guided in various directions around the colon. Air is used to gently inflate the colon ahead of the colonoscope. The camera allows a magnified colour picture of the colon wall to be shown on a television monitor. Any polyps or tissue removed can be sent to the laboratory for diagnosis.

What do I need to do before my procedure?

It is important that you give your colonoscopist full details of any other health problems you may have. You should also provide a list of all medications you take. The doctor may stop all aspirin and anti inflammatory drugs at least one week before the procedure. If taken beyond this point, your risk of bleeding from the bowel after the colonoscopy increases. Warfarin and other blood thinners are special cases and the colonoscopist must give clear instruction on when to take them. Iron supplements makes the bowel wall black and should be stopped one week before the procedure so the colonoscopist can get a better view of the bowel wall. If you are in any doubt about any of your medications, you should speak to your GP.
People with diabetes, pacemakers, heart valves and some other conditions also need specific advice before their procedure.

Preparing for a Colonoscopy: Cleaning the Large Bowel

It is essential that you have a clean bowel when the colonoscopy is performed – otherwise, something could be missed. The colonoscopist will ask you to take a bowel preparation (usually tablets or liquid) prior to the procedure. A thorough colonoscopy depends on a clean bowel.
Nobody likes taking bowel prep (it has other names, but let’s leave it at that). It comes in various brands and forms, but all have the one aim – to give you a “thorough” clean out!

A clean bowel helps to determine the quality of the colonoscopy. An unclean bowel can prevent the colonoscopist seeing the entire bowel and can result in another colonoscopy being required or a lesion being missed – with potentially fatal consequences. So remember, do your bit – give the colonoscopist a clean colon to work with. Follow the exact directions on how to take your bowel prep, when to stop eating solids (usually 12-24 hours before the procedure) and when to start fasting (usually 6-8 hours before the procedure).
If the doctor cannot perform a proper procedure due to an unclean bowel, it may have to be repeated earlier than planned.

The Colonoscopy Procedure

An intravenous sedative is usually given before the colonoscopy. Even though you are “awake” for the procedure, you should be relaxed and drowsy and will probably have no memory of the procedure.

A colonoscopy is usually performed on a table with the patient lying on their left side with their knees pulled up towards their chest. The colonoscope is inserted through the anus and air is introduced as the colonoscope is advanced through the rectum and colon. Once the colonoscope reaches the junction of the colon and small intestine (at the caecum), the doctor slowly withdraws it while closely inspecting the bowel wall. Photographs may be taken and polyps or other lesions biopsied (a small piece of tissue taken to examine under a microscope) or removed and sent to the laboratory for diagnosis. The whole procedure usually takes 15 -60 minutes.

The Colon and Rectum

The colon is a hollow tube about 1.5 metres long. The rectum is about 15cm long and joins the end of the colon. Attached to the rectum is the anus, a muscular structure which relaxes to allow faecal wastes to be expelled. Together, the colon and rectum make up the large intestine (or large bowel).

Semi solid digestive waste and unabsorbed food is moved from the small intestine to the large intestine where it is stored before being eliminated in the faeces. As it travels through the colon, moisture is absorbed and faeces formed.

How do I pick the right doctor?

Several factors influence the quality of colonoscopy. These include how clean the bowel is prior to inspection, the time taken to do the inspection and the experience and skill of the colonoscopist in manipulating the camera to view as much of the bowel as possible.

The procedure starts at the anus. The colonoscope is then advanced to the far end of the colon known as the caecum. Good colonoscopists identify certain anatomical landmarks at the caecum where it joins the small intestine and note this in their report. By doing this, they ensure they have viewed the entire large bowel. An equally important standard for colonoscopy is the time taken to withdraw the colonoscope from the caecum. It is during the withdrawal phase that the best views of bowel walls are gained and when most abnormalities such as polyps, are detected. This part of the procedure should take at least 6-7 minutes.

Some doctors recommend a certain “detection rate” of polyps when a colonoscopist screens people who don’t have symptoms, or when performing surveillance on patients known to have high risk. This may also be used as an indicator of quality colonoscopy.

What questions should I ask the doctor before I agree to a Colonoscopy?

How often do they get all around the bowel to the caecum?
Do they record their detection rates?
What is their “withdrawal time” during colonoscopy?
How many colonoscopies do they perform each year? (more than a hundred should be expected).
Are they accredited to perform colonoscopies?

More questions to ask your doctor.

What happens afterwards? Are there any side effects or risks?

After spending a short time in the recovery room, most people “wake up” from their colonoscopy and are sent home with no ill effects. Sedative or anaesthetic side effects are not common after colonoscopy, but you will be kept in the recovery room until the trained staff are certain you are ready to leave the hospital. Remember, driving or operating machinery is not recommended for at least 12 hours after your sedative.

More common side effects include abdominal bloating, pain and flatulence. This can result from the pumping of air into the colon during the procedure. This will usually resolve within a couple of days.
In rare cases, polyp removal or biopsy may cause excessive bleeding, which may require blood transfusion or re-insertion of the colonoscope to control the bleeding.
Tearing or perforation through the wall of the bowel is another very rare but serious consequence of this procedure. It is important that patients seek urgent medical advice if heavy or sustained bleeding commences or fever or severe pain occurs.

Follow up appointments

Your doctor should arrange a follow up appointment to discuss the colonoscopy findings, any tissue diagnosis made, the treatment required and the appropriate follow up. The latter may include F.O.B.T. (faecal occult blood testing – a sample of faeces is sent to the lab and tested for blood).
The timing for the next colonoscopy will depend on whether polyps have been found and their size and type. Your colonoscopist should give you a recommendation for the timing for your next colonoscopy and be prepared to discuss the reason for that recommendation.

What does nib cover me for?

The hospital you choose, your health insurance policy and hospital excess, and if you’re still serving waiting periods are just some of the things that affect how much your procedure will cost.
You should always contact nib BEFORE your procedure to ensure you’re covered.
Your out of pocket expenses may be minimised if you:
• Choose an nib agreement private hospital or public hospital
• Ask your doctor in advance if they’ll treat you as an nib MediGap patient, and if other people performing the procedure (e.g. anaesthetist) will be charging nib MediGap rates as well.
For more information visit Going to Hospital.

This same day procedure is INCLUDED on the following nib health insurance covers:

Basic Plus
Family Plus
Mid Plus
Top Cover
Young at Heart Mid
Young at Heart Top
Just Hospital

RESTRICTED BENEFITS apply for this procedure if you are on:

Basic Saver
Family Basic Saver

Note: the below covers are no longer available for sale
At nib agreement private hospital and public hospitals, this procedure is fully covered for hospital costs on

Gold
Bodyguard
Safeguard
Premier 65% and Premier 85%
Essentials
Top Private Hospital
Executive R

And, if the doctors and anaesthetists charge nib’s MediGap rate, there should be no out of pocket expenses for these services.

If you are on Public Hospital or Public Hospital Plus Extras, you will be fully covered if you are admitted to a public hospital, provided you are treated as a day patient. If your admission requires an overnight stay, or you are admitted to a private hospital, you will have out of pocket expenses.

Note:
This information should not replace the advice given to you by your doctor or other health care providers.