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Colorectal Surgery

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In colonoscopy and sigmoidoscopy, a gastroenterologist uses a special kind of endoscope (long, flexible, lighted tube) called a colonoscope or sigmoidoscope to view the inside of the large intestine (large bowel or colon). The doctor inserts the scope, which is about the thickness of a finger, into the anus and advances it to the rectum and colon. (See illustration.) With this instrument, the specialist can examine the colon, looking for cancerous areas, polyps, or other abnormal growths, for inflammation, for ulcers, for bleeding, or for other conditions. The gastroenterologist can see the lining of the rectum and colon, can remove samples of polyps or other tissue for evaluation (biopsy tissue for examination in the laboratory), and sometimes treat problems nonsurgically. For example, polyps are sometimes precancerous conditions and the specialist may remove them altogether, as a cancer-prevention step.

Specialists use sigmoidoscopy primarily to access the lower or descending section of the colon. Using the longer colonoscope, they can access the entire colon, including the transverse and ascending sections.

These procedures are the most important diagnostic for a number of important and common conditions, such as colorectal cancer, inflammatory bowel disease, and diverticulitis. These tests are performed as part of routine screening or in response to symptoms such as bloody stool or rectal bleeding or pain, change in bowel habits, or persistent diarrhea. Sigmoidoscopy and colonoscopy are more accurate than barium x-rays in detecting small abnormal areas.

In order to prepare for this test, patients go on a clear liquid diet for 24 hours prior to the procedure and take a bowel-cleansing preparation. Patients taking blood-thinning medications, antiplatelet medications, or arthritis medications will need to discuss with their physician the need to stop these medications several days prior to the procedure. The staff places the patient under mild sedation just prior to the procedure.

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