More about colonoscopy and sigmoidoscopy - what are these Exams

By these examinations the doctor inserts a tube-like instrument through the rectal opening to look inside the terminal part of the digestive tract. By sigmoidoscopy the instrument is only inserted up inside the last part of the colon, the Colon sigmoidum. By colonoscopy the instrument is advanced through most of or all parts of the colon, and sometimes even a little way up into the small intestine. The doctor can do several actions through that instrument:

- He can look into and inspect the anus and the colon.
- He can take pictures and viedos from the inside.
- He can pump up the colon with air or gas to be able to look better or as a part of a treatmnet.
- He can take small speciments of tissue ffom inner lining of the intestine.
- He can remove small polyps or tumors.


ABOUT THE SIGMOIDOSCOPE OR COLONOSCOPE

A colonoscope is a long flexible, tube-like instrument with a tip that can be bent in several directions so that it can be negotiated through sharp curvatures in the intestine. It is possible to perform both sigmoidoscopies and colonoscopies with that intsrument.

A sigmoidoscope can can be constructed just like the colonoscope, but it is shorter and therefore more practical to handle. A sigmpidoscope can also be rigid. A rigid sigmoidosocpe can be an advanced optical instrument just like a colonoscope, but can also be only a hollow tube.

A colonoscope and an advanced sigmoidoscope have a tube-like part that the doctor inserts and a larger base with an eyepiece, a handle, controle buttons and connections to a computer and to sources or pumps for gas or air..

The imaging capabilities is either made possible with a camnera at the tip or by optical fibers to conduct the image back. The instrument also has fibers to lead light from the base to illuminate the intestinal inside and an internal channel to be used for specimen taking.


Preparation and anesthesia during sigmoidoscopy and colonoscop

The area that shall be examined must be clean. For a sigmoidosocpy a small enama to clean out the terminal part of the colon and to stimulate a bowel movement is often used for this purpose.

For a colonoscopy the patient usually has to stop eating at least24 hours before the examination and also often he is requred to take a laxative to ease the passage of all intestinal content some hours before the exam. Sometimes also a larger enama is admistered.

If these examinations are done in a gentle manner, and the patient feels comfortable, no anesthesia is strictly necessary, except some oral pain-killing medication, or some relaxing medication, and a numbing gel in the rectal opening.

For a colonoscopy doctors prefere however usually to sedate the patient so that he is sleeping. The most frequent reason mentioned in professional medical litterature for anesthesia used during these procedures is to hinder the patient from remembering the procedure and not to hinder pain.

Most often the patient is sedated with a anesthetics given through a tube into the blood-stream - intravenous sedation. One generally uses a so high dosis however that the patient shall not remmeber anything or very little after the exam, but still the patient sometimes do remember a lot, regardless of the dosis.

Sometimes heavier sedation is used. By heavy sedation, the patient do not any longer have any controle of his or her body reflexes, and all vitals must be monitored all the time. Heavy sedation is mostly used on small children and sometimes on teenagers. This degree of anesthesia implies heavier risk and more dicomfort after the procedure

Sometimes even general anesthesia is used. General anesthesia will most often be used when the colonoscopy contains manipulations that could give great pain or that necessiatates the patient to be absolutly still-laying, or the patient asks for this to be done. Also here an objective is to hinder the patient from remembering the procedure. Some institutions use general anesthesia as a standard for children and teenagers. By general anesthesia, the patient do not manage to breath properly or has medication to paralyze the breathing. Therefore the patient is usually intubeted and is given artificial respiration.

General anesthesia is also mostly used on the youngest patients. But this method implies heavier risks and the risks are heaviest on the youngest patients that most often are subjected to this type of anesthesia and on elderly of weak patients. Also the discomfort after heavy anesthesia tend to be heavy. The use of heavy anesthesia during colonoscopy and sigmoidoscopy will in most cases give more discomfort afterwards that if the procedure had been performed in a careful fashion without heavy anesthesia. The objective to use heavy anesthesia during these procedure seems primary to controle the patient, to hinder memory, and to hinder the patient from telling details from the procedure to other persons.


How the exam is performed

The position of the patient vary considerably for these exams. A common position is letting the patient lay on the side with the knees flexed towards the breast. During the exam the patient may be shifted to a position of lying on the back.

For a rigid sigmoidoscopy the patient sometimes lies at his stomach with spread legs or with the legs flexed downwards, or even have the legs in stirrups while lying at the back.

The lubricating and numbing gel is then inserted through the rectal opening and let some time to have its effect.

Then the scope is inserted through the anus and gradually advanced until it reaches the destination. During the advancement the intestine is inflated to ease passage and give a better view.

Inside the anus and colon, the doctor will look at every corner as it is advanced.. He may also insert a very thin probe through the scope to take out small specimens.

Then the scope is gradually taken out again. During this process the doctor inspects the intestine even more thooroughly and takes specimens if necessary.

It is also possible to clip loose polyps and small tumors with equipment inserted through the scope.

If it is necessary to do such surgical acts during the exam, the anesthesia may be deepened to hinder the patient from feeling pain.


Use of endoscopies for preventive health controle of healthy children and adults without symptoms

For some time already sigmoidoscopy or full colonoscopy with regular intervals has been commonly done on persons over 50 years old to detect early signs of canser or any other disease in the lower digestive tract for persons over 50 years, usually done under sedation so that the person is unconscious.

How much this is recoomended varies however from area to area in the world and between institutions providing medical care. Full colonoscopy under sedation gives a risk that might not be worth the benefit. But with modern endoscopic techiques done in a gentle way, sedation is not necessary. The sedation is more for the benefit of the staff than the patient.

Steadily more societies around the world have also begun to subject children at specific ages to a battery of endoscopic examinations at specific ages, especially around age 6-8, 11-13 and 15-17. The exact age when the child is called in tend to vary with the development speed of the child. Usually these are done under deep sedation or general anesthesia.

The most common endoscopies done during these ordeals are cystoscopy, sigmoidoscopy, colonoscopy and inspection through the esophagus down into the upper digestive tract. During the ordeals one also tend to perform ultrasound exams of the genitals, pelvic area, breast area, stomach area, jaws and the major joints, and even x-ray pictures of the joints.

In at least some of these areas one places electronic chips into the body of the child so that authorities in the community can surveil the wherabout and status of the child around the clock by wireless communication. This is usually done whithout telling neither the kid, nor the parents about it.

There is little information about these examination programs to the general population, and the parents usually get to know about it when the child is called in.

Both the anesthesia given and the endscopies themselves carry a risk for the child, and it is doubtful if these programs are of the best interest of the child and the families. Also the secret placement of surveillance chips is clearly unethical. The main reason for these programs seems to be surveillance, controle, research and harvesting of tissue for the benefit of others than the kid.

With modern endoscopic techiques deep sedation or general anesthesia is not necessary by simple endoscopies. By carrying out these programs only with simple relaxing and analgesic measures and only performing moderately intrusive endoscopies, and without electronic chipping, these programs might be beneficial.