Colonoscopy

Complete visual examination of the colon and rectum using a flexible endoscope, essential for the screening and diagnosis of colorectal conditions.

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What is it?

Colonoscopy is the gold-standard examination for exploring the colon (large intestine) and the rectum. It involves inserting a flexible endoscope, fitted with a high-definition camera, through the anus in order to visualize the entire colonic lining. This examination is fundamental for colorectal cancer screening, the second leading cause of cancer death in Tunisia. Colonoscopy can detect and analyze colonic polyps, tumors, chronic inflammatory bowel diseases (Crohn's disease, ulcerative colitis), diverticula, infectious colitis and vascular malformations. A major advantage of this examination is the ability to perform therapeutic procedures at the same time, such as polyp removal (polypectomy), thereby avoiding surgery. Bowel preparation is an essential step for the success of the examination. It requires a low-residue diet for 2 to 3 days and taking a bowel-cleansing solution the day before and the morning of the examination. A perfectly clean colon allows optimal exploration and reduces the risk of missing lesions. At Clinique Pasteur in Tunis, colonoscopy is performed under deep sedation provided by an anesthesiologist, guaranteeing total comfort for the patient. The gastroenterologists use latest-generation colonoscopes with virtual chromoendoscopy for improved detection of flat or small lesions.

When is it indicated?

Colorectal cancer screening from age 45, or earlier in case of family history

Even without symptoms, screening colonoscopy makes it possible to spot and remove polyps before they turn malignant. It is the most effective way to prevent colorectal cancer.

Positive screening test (blood in the stool)

When a screening test reveals traces of blood invisible to the naked eye, colonoscopy is essential to determine the origin, most often benign, such as a polyp or hemorrhoids.

Persistent change in bowel habits (diarrhea, constipation)

A lasting change in bowel habits, with no obvious cause, warrants an examination of the colon to check the condition of the lining and rule out a lesion.

Rectal bleeding (blood in the stool)

The presence of red blood in the stool must always be investigated. Colonoscopy identifies its exact source and can treat it if necessary during the same examination.

Unexplained iron-deficiency anemia

Unexplained iron deficiency may be linked to silent bleeding in the colon. Colonoscopy looks for the responsible lesion in order to treat it and durably correct the anemia.

Unexplained chronic abdominal pain

When abdominal pain persists without explanation despite initial tests, colonoscopy makes it possible to directly check the condition of the large intestine and guide the diagnosis.

Surveillance after polypectomy or colorectal cancer

After polyp removal or treatment of colon cancer, regular follow-up colonoscopies verify the absence of new lesions and provide reassuring monitoring.

Assessment of chronic inflammatory bowel disease

For Crohn's disease or ulcerative colitis, colonoscopy assesses the extent and intensity of the inflammation, which helps the physician choose and adjust the treatment.

Preparation

1Low-residue diet (no fruit, vegetables or whole grains) for 2 to 3 days before the examination

2Take the bowel preparation (cleansing solution) according to the prescribed protocol the day before and the morning of the examination

3Fast strictly for at least 6 hours before the examination

4Report any anticoagulant or antiplatelet treatment (adjustment required with the prescribing physician)

5Mandatory pre-anesthesia consultation if the examination is performed under sedation

6A companion is mandatory for the trip home

7Do not drive for 24 hours after sedation

Procedure

The patient lies down on their left side

Sedation is administered intravenously by the anesthesiologist

The colonoscope is gently inserted through the anus

Air is insufflated to open up the colon and allow good visualization

The endoscope is advanced to the cecum (the junction with the small intestine)

A meticulous examination is performed as the endoscope is withdrawn

Any polyps detected are removed during the same procedure whenever possible

Biopsies are taken from any suspicious lesion

The patient is monitored in the recovery room for 1 to 2 hours

Duration

20 to 45 minutes for the examination, 2 to 3 hours in total including preparation and monitoring

Results

The gastroenterologist communicates the visual findings to the patient and their companion after they wake up. The results of biopsies and of the analysis of removed polyps are available within 7 to 14 days.

Risks and side effects

Bloating and moderate abdominal pain after the examination (common and transient)

Bleeding after polypectomy (1 to 2 % of cases, usually minor)

Colonic perforation (rare, about 1/1000 for colonoscopies with polypectomy)

Post-polypectomy syndrome (abdominal pain and fever, rare)

Anesthesia-related complications (rare)

These risks remain rare. Your physician will inform you in detail before the examination.

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At a glance

Duration: 20 to 45 minutes for the examination, 2 to 3 hours in total including preparation and monitoring

Preparation: Required

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