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Conscious sedation drugs
Colonoscope and video
Biopsy forceps, snare,
Evaluation of a
Screening of asymptomatic
individuals for colon neoplasia or cancer
Evaluation of unexplained
Examination for a
synchronous colon neoplastic lesion when a lesion is found in
Surveillance or follow-up
study after removal of a prior neoplastic lesion
bowel disease or surveillance for previously diagnosed
inflammatory bowel disease
Evaluation of symptoms
suggestive of significant colon disease (e.g., chronic diarrhea,
weight loss, abdominal or pelvic pain)
(e.g., polyp removal, foreign body removal)
Recent (<3 months)
Recent (<1 week)
Coagulopathy or bleeding
Known or suspected
When the procedure
results will not produce a change in management
PITFALL: Sliding the scope along the colon
wall (i.e., slide-by technique) is not advocated, as this
technique may result in perforation at the rectosigmoid
PITFALL: Colonic explosion has occurred in
individuals undergoing electrosurgical polypectomy.
Explosion of intraluminal methane gas is unlikely if the
colon has been adequately prepped.
PITFALL: Reinsertion of the scope may be
needed if the scope has to be withdrawn to remove a large
polyp. The polyp may obscure the scope tip, making adequate
visualization of the colon wall during withdrawal
PITFALL: Occasionally, polyps fall away or
are mishandled, or a large number must be removed.
Unretrieved polyps can be recovered after the procedure.
Patients may strain to move them out of the colon, or added
bowel prep solution (i.e., polyethylene glycol solution or
phosphate enema) can be administered through the scope to
induce evacuation. The fluid is filtered so that the polyps
can be recovered for histologic examination.
PITFALL: Suspected perforation after
polypectomy necessitates hospital observation and
Perforation: 1 to 2 per
1,000 procedures (studies from diagnostic colonoscopies only,
Adverse reaction from
sedatives such as respiratory depression, allergic reaction, or
for endoscope cleaning appear in Appendix
K: Recommendations for Endoscope
endoscopy equipment such as endoscopes, light sources, video
endoscopy monitors, cleaning and disinfection aids, and
mouthpieces are available from the following
Corporation, Center Valley, PA (http://www.olympusamerica.com)
Instrument Corporation, Montvale, NJ (http://www.pentaxmedical.com)
materials (e.g., intracaths, normal saline solution,
intravenous tubing) can be obtained from local hospitals or
surgical supply houses.
Propofol (1% Diprivan) injection
is available from AstraZeneca, Wilmington, DE
(http://www.astrazeneca-us.com). Meperidine (Demerol) injection is
available from Wyeth-Lederle (http://www.wyeth.com). Midazolam (Versed)
injection is available from Roche, Nutley, NJ (http://www.roche.com).
monitoring patients receiving conscious sedation appear in Procedural (Conscious)