Colonoscopy

Colonoscopy or coloscopy is the endoscopic examination of the large bowel and the distal part of the small bowel with a CCD camera or a fiber optic camera on a flexible tube passed through the anus. It may provide a visual diagnosis (e.g. ulceration, polyps) and grants the opportunity for biopsy or removal of suspected colorectal cancer lesions.

Colonoscopy can remove polyps as small as one millimetre or less. Once polyps are removed, they can be studied with the aid of a microscope to determine if they are precancerous or not.

Colonoscopy is similar to, but not the same as, sigmoidoscopy—the difference being related to which parts of the colon each can examine. A colonoscopy allows an examination of the entire colon (1200–1500 mm in length). A sigmoidoscopy allows an examination of the distal portion (about 600 mm) of the colon, which may be sufficient because benefits to cancer survival of colonoscopy have been limited to the detection of lesions in the distal portion of the colon.

The American Cancer Society "Guidelines for the Early Detection of Cancer" recommend, beginning at age 50, both men and women follow one of these testing schedules for screening to find colon polyps and cancer: 1. Flexible sigmoidoscopy every 5 years, or 2. Colonoscopy every 10 years, or 3. Double-contrast barium enema every 5 years, or 4. CT colonography (virtual colonoscopy) every 5 years.

A sigmoidoscopy is often used as a screening procedure for a full colonoscopy, often done in conjunction with a fecal occult blood test (FOBT). About 5% of these screened patients are referred to colonoscopy.

Virtual colonoscopy, which uses 2D and 3D imagery reconstructed from computed tomography (CT) scans or from nuclear magnetic resonance (MR) scans, is also possible, as a totally non-invasive medical test, although it is not standard and still under investigation regarding its diagnostic abilities. Furthermore, virtual colonoscopy does not allow for therapeutic maneuvers such as polyp/tumour removal or biopsy nor visualization of lesions smaller than 5 millimetres. If a growth or polyp is detected using CT colonography, a standard colonoscopy would still need to be performed.

Colonoscopy is not recommended for patients having an active flare of ulcerative colitis or Crohn's disease to avoid a perforation of the colon. Additionally, surgeons have lately been using the term pouchoscopy to refer to a colonoscopy of the ileo-anal pouch.