New Users Registration  |  Useful Links  |  FAQ  |  Site Map 
 
Go Search

 

Skip Navigation LinksHealth Xchange > News
  News  
  Categories  
     
  Chronology  
 
  2013 2014   Dec 2014 | Nov 2014 | Oct 2014 | Sep 2014 | Aug 2014 | Jul 2014 | Jun 2014 | May 2014 | Apr 2014 | Mar 2014 | Feb 2014 | Jan 2014 |
  2013   Dec 2013 | Nov 2013 | Oct 2013 | Sep 2013 | Aug 2013 | Jul 2013 | Jun 2013 | May 2013 | Apr 2013 | Mar 2013 | Feb 2013 | Jan 2013 |
  2012   Dec 2012 | Nov 2012 | Oct 2012 | Sep 2012 | Aug 2012 | Jul 2012Jun 2012May 2012Apr 2012Mar 2012 | Feb 2012 | Jan 2012 |
  2011   Dec 2011Nov 2011Oct 2011 | Sep 2011 | Aug 2011Jul 2011Jun 2011 | May 2011 | Apr 2011 | Mar 2011 | Feb 2011 | Jan 2011 |
  2010   Dec 2010 | Nov 2010 | Oct 2010 | Sep 2010 | Aug 2010 | Jul 2010 | Jun 2010 | May 2010 | Apr 2010 | Mar 2010 | Feb 2010 | Jan 2010 |
  2009   Dec 2009 | Nov 2009 | Oct 2009 | Sep 2009 | Aug 2009 |
 
     
  Topic  
 
  Health Policy and Announcements | Diseases and Outbreaks
  Medical Research | New Treatments and Technology
   
 
     
  RSS  
 
  Singapore   SingHealth | Health Promotion Board | Ministry of Health | Asiaone
  International   World Health Organization | Centre for Disease Control and Prevention (US)
       
 
     
  News Article  
 

Your step-by-step guide to Colonoscopy

 
  Thursday, 26 l 05 l 2011  Source: Mind Your Body; The Straits Times   
By: Ng Wan Ching
     
 

WHO SHOULD GO

Three categories of patients should be screened.

  • Those at very high risk – those with a family history of hereditary colon cancer.
  • Those at high risk – those in the family with a first-degree relative (parent, child or sibling) with colon cancer, especially when this relative was younger than 60 years old at diagnosis.
  • Those at average risk – those who are 50 years old or older. Most people will fall into this group, which the Ministry of Health is targeting.

colonoscopyTESTS

The screening for the first two groups is colonoscopy, a visual examination of the colon and rectum through a scope. Those who are at average risk have the choice of taking the faecal occult blood test, computed tomography (CT) colonography, barium enema or colonoscopy.

The faecal occult blood test looks for blood in the stools. CT colonography is a medical imaging procedure which uses X-rays and computers to produce two- and three-dimensional images of the large intestine from the lowest part, the rectum, to the lower end of the small intestine.

In a barium enema test, the doctor fills the colon with a contrast material, barium, through the rectum and takes an X-ray of the abdomen.

The choice of the test will have to be worked out with the individual as the accuracy, cost and level of the individual’s involvement varies. The blood test is the easiest but the least accurate.

Colonoscopy is arguably the most accurate and offers the opportunity for immediate removal of polyps, the precursors to cancer. However, it is more involved, requiring a day off work and preparation to cleanse the colon. It also carries risks of bleeding and perforation during the procedure. As it is so accurate, it needs to be considered only once every 10 years if the first one is normal, unlike the blood test, which should be done annually. The blood test detects only cancer and larger polyps that bleed and not smaller polyps in the pre-cancerous stage. A positive result requires follow-up colonoscopy.

Associate Professor Tang Choong Leong, who heads colorectal surgery at Singapore General Hospital, said: “However, if after normal colonoscopy, you develop symptoms such as blood in the stools or a change in your bowel habits, you should come in for colonoscopy again.”

HOW

You need to cleanse your bowels either the day before or on the morning of the colonoscopy. A lavage solution (an isotonic salt solution) has to be consumed in a specified time of two to three hours. This will result in watery loose stools or just plain water being passed out at the end of the preparation so that the inside of the colon is clean for direct inspection using the colonoscope. There is no pain involved in the preparation.

SCREENING

Most patients are sedated during the procedure with a short-acting tranquilliser injected intravenously. Some may choose to undergo the procedure awake. Most experience bloating, distension and occasionally spasms if the scope traverses a bend or twist in the colon. A fibre-optic tube, the thickness of an index finger, is introduced through the anus and the surgeon will pass it up the large intestines all the way to the beginning, the caecum. The colon is inspected twice – during insertion and also during withdrawal of the tube.

If a polyp is detected and is small and safe enough to be removed immediately, then forceps or a wire loop is inserted through a channel in the scope to grip, cut and remove the polyp. Bleeding is stopped by an electric current. This is entirely painless even if the person is awake and watching.

The colonoscopy and polyp removal take more than 10 minutes, depending on the degree of natural twisting in the colon, the cleanliness of the preparation, and the number, size and location of the polyps that can be removed. Provisional findings are known immediately and the discharging nurse will usually inform the patient of the results before he or she leaves. The removed polyps may be sent for further testing. In this case, the results will be reviewed at a follow-up visit one to two weeks later.

WHAT DOCTORS LOOK OUT FOR

polypAnything that looks abnormal. Doctors may perform a biopsy on larger polyps that cannot be removed through the scope. This means a pair of small forceps is passed down the scope to pinch a small sample for testing.

RISKS

Colonoscopy carries a risk of bleeding and perforation, especially with the removal of polyps, in the region of eight per 1,000 procedures carried out and one per 1,000 respectively. Most bleeding is minor and stops spontaneously. In severe and persistent cases, repeat colonoscopy may be needed or even surgery to stop the bleeding. Most perforations would require surgery for repair.

COST

Most hospitals here carry out this procedure. With subsidies, the average bill for colonoscopy can cost between $300 and $700. Without subsidies, it is at least $1,000. The cost varies depending on the seniority of the doctor doing the procedure and if other tests are required. The Medisave withdrawal limit will be pegged at the prevailing withdrawal limit for day surgery procedures, at $950 for colonoscopy and $300 per day for associated daily hospital charges. It is applicable only for colonoscopy done in Singapore. The list of institutions approved to carry out the procedure for which Medisave can be used will be out closer to July 1.

Source: Associate Professor Tang Choong Leong, head of colorectal surgery at Singapore General  Hospital, and Ministry of Health.

     
  Ask the Specialists - Free Doctor Q&A
(Now - 30th Aug)
 
    Cornea-Related Eye Conditions
If you have questions on cornea-related eye conditions like pterygium, dry eyes or eye infections, take this opportunity to ask our expert today.
 
    Previous Q&As
Check out our archive for all our previous doctor's Q&As!
*Latest Update: About LASIK
 
e-Appointment Online
Health Buddy App