What Is Colonoscopy Sedation?

Colonoscopy is a commonly used fiberscope in clinical practice. The rectum, sigmoid colon, descending colon, transverse colon, ascending colon, and cecum, as well as a small segment of the small intestine (the ileocecal end) connected to the large intestine, can be detected by retrograde insertion of the anus. Intestinal lesions can be clearly found, and some intestinal lesions can be treated at the same time, such as: benign lesions such as large bowel polyps are removed directly under the microscope, intestinal bleeding is stopped under the microscope, and foreign bodies in the large intestine are removed.

Chinese name: Colonoscope
Foreign name: colonoscope

Category Name: Medical endoscope
Management category: Class II / III medical devices

Colonoscopy History

There are two types of colonoscopy: a metal rigid tube and a fiber colonoscopy. The metal rigid tube has been abandoned because of the great pain; most hospitals use fiber colonoscopes, and only a few hospitals that cannot afford fiber colonoscopes still use rigid tube colonoscopes. Fiber colonoscopy was transmitted to China in the early 1970s, and many hospitals in China have carried out this examination after 1975. In the 1980s, the American Welch-Allyn company took the lead in developing the electronic endoscope, which made the endoscope technology enter the electronic age, and has been widely used in clinical practice ^[1] .

Colonoscopy basic structure

Fiber colonoscopes are optical endoscopes, which usually consist of an objective lens system and an optical transmission / transmission system, with or without an observation eyepiece system to form an observation optical path. Can include attachments. Attachments are accessories or stand-alone products for use with endoscopes ^[2] .

The electronic colonoscope belongs to the electronic endoscope and usually consists of an objective lens system, an image front photoelectric sensor, and an A / D conversion integrated module. The object in the cavity to be observed is imaged on the image front photoelectric sensor through a tiny objective lens system, and then the received image signal is sent to an image processing system, and finally the processed image is output on a monitor ^[2] .

Colonoscopy indication

Unexplained stool blood or persistent fecal occult blood positive;
People with lower gastrointestinal symptoms, such as chronic diarrhea, long-term progressive constipation, changes in bowel habits, and unclear diagnosis of abdominal pain, bloating, and abdominal mass;
X-ray barium enema examination for those with suspected terminal ileum and colonic lesions, or those with uncertain nature of the lesions;
X-ray barium enema examination is negative, but there are obvious intestinal symptoms or suspected malignant changes;
Low bowel obstruction and abdominal mass, can not rule out colon disease;
Unexplained weight loss and anemia;
Those who need colonoscopy, such as colon polypectomy, hemostasis, sigmoid torsion, or intussusception reduction;
Those who need to check the anastomosis after colectomy;
Those who need regular colonoscopy after colon cancer surgery, after polypectomy and inflammatory bowel disease medication;
Those who need colonoscopy to assist in the exploration and treatment of bowel diseases;
Those who need to be screened for colorectal diseases ^[1] .

Colonoscopy Contraindications

Severe cardiopulmonary insufficiency, shock, abdominal aortic aneurysm, acute peritonitis, and intestinal perforation are absolute contraindications ^[1] .

The following are relative contraindications:

Pregnancy, extensive adhesions in the abdominal cavity and various causes of intestinal stenosis, chronic pelvic inflammatory disease, cirrhosis, ascites, mesenteric inflammation, abnormal bowel flexion, and advanced cancer with extensive intra-abdominal metastasis. Experienced surgeons proceed carefully;
Severe ulcerative colitis, patients with multiple colon diverticulum should see the bowel cavity into the scope, do not use the slide-in method to advance the colonoscope;
Those who have undergone abdominal surgery, especially pelvic surgery, have suffered from peritonitis, and have a history of abdominal radiotherapy should enter the mirror slowly and gently. If severe pain occurs, the examination should be terminated to prevent intestinal wall tears and perforations;
Weak and elderly patients, as well as those with severe cardiovascular and cerebrovascular diseases, who cannot tolerate the examination, must be cautious during the examination;
There are severe purulent inflammation or painful lesions in the anus and rectum, such as perianal abscesses and anal fissures. Those who cannot tolerate the examination must be cautious during the examination;
Children and people with mental illness or who cannot cooperate should not be examined, if necessary, under general anesthesia;
Women's menstrual periods are generally not suitable for testing.

Colonoscopy Maintenance

Colon cleaning and disinfection commonly used trough manual cleaning and disinfection method. Must go through: cleaning-disinfection-aseptic storage 3 steps. It is important to fully clean, not only can remove large dirt, but also reduce pathogenic bacteria to the extent that it is difficult to cause infection, and can improve the disinfection effect of disinfectants. Colonoscopy accessories (such as metal products such as biopsy forceps) can be autoclaved ^[1] .

The basic principle:

All colonoscopy accessories that penetrate the mucosa, such as biopsy forceps, guidewires, wire baskets, high-frequency electric knives, etc. must be disinfected.
The colonoscope and accessories should be washed, disinfected or sterilized immediately after use, and use a timer to control the disinfection or sterilization time.
Colonoscopy should be performed using flowing water.
Records of colonoscopy cleaning and disinfection should be complete, and the registration content should include the name of the patient, address, telephone and number of the colonoscopy used, the time of cleaning, the time of disinfection, the name of the operator and the name of the disinfectant.

Colonoscopy Colonic Symptoms

Most of the onset of this disease is slow, a few can be acute, with a chronic course, which lasts for several years to more than ten years, often with altered or persistent exacerbations, and occasionally an acute outbreak, clinical manifestations:

Diarrhea: mucus and pus and blood, 3-4 times a day in light cases, dozens of times in severe cases or diarrhea and constipation alternately.
Abdominal pain: Mild patients have no abdominal pain or only abdominal discomfort. Generally, there is mild to moderate abdominal pain, which is a pain in the left lower abdomen or lower abdomen, which can involve the rule of pain in the whole abdomenfeelingafter remission.
Constipation, bowel movements once every 4-5 days, stools like sheep feces, and even laxatives can not be defecation.
Other symptoms: abdominal distension, weight loss, fatigue, bowel sounds, insomnia, dreaminess, cold and other symptoms.

Colonoscopy colitis diagnosis

Colitis is relatively easy to confirm in daily life. If you have diarrhea and unfeasible stools, abdominal pain, bowel sounds, constipation, mucus, and pus and bloody stools, the disease can be controlled by taking sulfa and antibiotics at the beginning of the disease. After repeated relapses, The effect of this medicine is very small, you should go to the local hospital to ask a specialist to help diagnose. 1993 National Symposium on Chronic Non-Infectious Intestinal Diseases

Colonoscope The situation formulates 3 trial diagnostic criteria:

For ulcerative colitis, colitis with clear etiology such as bacillary dysentery and amoebic colitis must be ruled out.
It has typical clinical manifestations of recurrent diarrhea, abdominal pain, mucus, and pus, and at least one of the characteristic changes of colonoscopy "X-ray".
Clinical manifestations are not typical, but there are typical colonoscopy or X-ray findings or histological findings of mucosal biopsy.

Colonoscopy and Colitis Classification

Colonoscopy clinical typing

The clinical classification of colitis is conducive to treatment and prognosis. According to the clinical manifestations and clinical course of the disease, it is divided into the following four types:

Mild type: most common, slow onset, mild symptoms, mild diarrhea, less than 4 times a day, and alternate with constipation. There is no systemic symptoms in the stool without or only a small amount of blood mucus. The lesions are mostly limited to the rectum and sigmoid colon. The blood condition is normal.
Moderate: Between mild and severe, diarrhea more than 4 times a day, and mild systemic symptoms.
Severe type: fever, burnout, weight loss, anemia and other systemic manifestations of diarrhea more than 6 times a day, bloody stool or mucus pus and bloody stool.
Burst: Rare.

Colonoscopy TCM classification

TCM recognition: Colitis is mostly caused by damp-heat stagnation, spleen and kidney deficiency, qi and blood deficiency, qi stagnation and blood stasis, eating disorders, overwork, and mental factors. After more than 20 years of clinical experience and many experts worked together to summarize a relatively complete set of unique TCM classification and treatment, I have achieved a peculiar curative effect in the clinic, which has a certain effect on curing colitis and preventing colon cancer.

Types of diarrhea: diarrhea, unformed stools, abdominal pain, blood in the stool, mucus, pus and blood, bowel movements, and poor bowel movements, inexhaustible, severe after anxiety, accompanied by weight loss, general weakness, chills, dizziness, etc. (This type is the easiest to treat, and usually can be cured in 20-60 days)
Constipation type: constipation, such as sheep feces, poor bowel movements, endless, and even inability to pass stool within a few days, some patients have a long history of diarrhea, with abdominal pain, weight loss, dry mouth, abdominal distension and anemia, etc. Perishable. (Treatment is generally 30-60 days)
Alternating diarrhea and constipation: dry and thin when stools, mucus and blood in the stool, accompanied by abdominal pain and bloating. (Treatment is usually 20-60 days)

Preparation before colonoscopy

Before taking a colonoscopy, you only need to start eating liquid or semi-liquid diet 3 days before the test. On the morning of the test, you will be fasting. On the night before the test, you will take a laxative such as mannitol to clean the intestine, so as not to affect the observation and operation. To ensure cleanliness of the intestine. During the examination, the doctor will inject a certain amount of gas into the intestinal cavity through the colonoscope to facilitate observation. Due to the tortuous structure of the colon, the examinee may have different degrees of pain or traction during the examination. As long as the examinee can calmly and actively cooperate with the doctor's instructions, most people can tolerate and complete the examination. For subjects with excessive strain or high intestinal cramps, sedatives or antispasmodics are required. For children who cannot cooperate, it needs to be performed under anesthesia. The injected gas was aspirated before the examination was over, and most people did not notice any discomfort. If no lesions are found and no treatment is performed, the subject can move and eat normally.

Colonoscopy colonoscopy response

Colonoscopy sigmoidoscopy

The sigmoidoscopy is very short, the entrance is relatively smooth, and the examination time is short, so the pain is not great, only bloating, foreign body sensation and defecation.

Colonoscopy fiber colonoscopy

Because the colon is long, the sigmoid colon bowel is free, the anorectal folds are more susceptible to looping, and the insertion of the microscope is difficult. The two bend angles of the colonic spleen curvature and colonic liver curvature are often less than 90 °, and it is difficult to pass the mirror. Colonoscopy is laborious, time-consuming, and painful ^[3] .

Colonoscopy precautions

Can not see the bowel cavity can not be inserted blindly. The operation should be gentle, avoid blind and violent advance, so it is easy to damage the intestinal wall and cause perforation. When the bowel cavity is not clear or the advancement is obstructed, you can wait for a while or step back to the mirror before advancing.
Do not inject too much air. Due to excessive gas injection, the intestinal tension increases, and perforation is easy to cause, especially those with colonic lesions. Due to concerns about perforation, some people have suggested that it is better not to inject or to inject as little gas as possible. But beginners often can't see clearly and just inject a lot of gas, which is very dangerous.
Colonoscopy should not be too deep, too deep, or excessive tissue tearing, which may also cause bleeding or perforation.
Once intestinal perforation occurs, close observation should be carried out immediately, abdominal fluoroscopy should be performed, and timely surgery should be performed after diagnosis.

Colonoscopy timing

The earlier the colonoscopy is performed in a day, the earlier the tumor tissue can be found, and the colonoscopy in the morning is better than the afternoon.

In recent years, due to the increasing threat of colorectal cancer to people's lives, it is recommended to perform an anal digital examination every year after the age of 40; a fecal occult blood test should be performed every year after the age of 50, and a colonoscopy 3 to 5 years to detect early Colonic polyps and other precancerous lesions were removed in time.

Colonoscopy colitis treatment

Chronic colitis is an autoimmune disease, which may be related to some pathogen infections, genetic genes and mental factors. Most of them have a long course and are difficult to heal. Especially ulcerative colitis, stools with mucus and pus, and the patient is very distressed. These symptoms can not be solved by conditioning the spleen and stomach, and strengthening the spleen and intestines, but should be based on cold and heat tonifying, strengthening the spleen, and regulating yin and yang, and fundamentally treat enteritis.

Liu, a patient in Shandong, has suffered from abdominal pain and diarrhea for 5 years. He has taken many Chinese and western medicines and started to take effect. The worse the effect, the worse the effect. At the consultation, the patient had diarrhea worsening, mucus in the stool, 5-6 times a day, heavy after anxiety, a burning sensation in the anus after the stool, and a good diet, but he had to go to the toilet after eating. The movement was slightly delayed, the stool could not be controlled, and the body gradually lost weight. Exhausted. The tongue is red, white and greasy with weak pulses. According to the condition, use spleen and dampness, cold and heat tonic method to treat. After taking 15 doses of medicine, the number of stools is reduced, 3 times a day, but there is still mucus and not formed. Basically returned to normal. The patient thought that it was completely good, but did not consolidate the treatment, but the condition recurred due to inadequate diet. The bowel movement was 3-4 times a day. The symptoms were basically the same as before, but the reaction was mild. The stool basically returned to normal, and another 15 doses were taken to completely return to normal without recurrence.

For the treatment of colitis, Guan Jian is in the prescription. Tonics are not necessarily used for a large number of stools. Combination of syndrome differentiation and disease differentiation should be combined. Righting is to cure the root cause, and to eliminate evil is to eliminate inflammation so that the effect can be better.