Colonoscopy Procedures and Standards
Published: 23 February 2021
Published: 23 February 2021
Bowel cancer is the third most common and second most deadly cancer in Australia (Bowel Cancer Australia 2020).
Colonoscopies are crucial in the early recognition and treatment of bowel cancer, and may lead to an increased chance of survival (ACSQHC 2020).
There are over 900 000 colonoscopies performed in Australia every year. The Colonoscopy Clinical Care Standard aims to ensure these procedures are performed safely and appropriately (ACSQHC 2020).
A colonoscopy is a diagnostic procedure wherein the inside of the colon (large bowel) is examined for signs of bowel cancer or illness (Healthdirect 2020).
It is performed using a flexible tube known as a colonoscope, which is inserted into the anus and guided through the colon. The colonoscope uses a camera and light to transmit a clear, magnified image of the colon lining to a monitor while it is being maneuvered (Better Health Channel 2018).
The clinician may need to remove polyps (potentially cancerous growths on the colon lining) or collect tissue samples during the procedure (ACSQHC 2020).
(Better Health Channel 2018)
Generally, colonoscopies are indicated for patients who:
(Healthdirect 2020; Better Health Channel 2018; Cancer Council Victoria n.d.)
Due to the potential harms of colonoscopies, the Royal Australian College of General Practitioners does not recommend colonoscopies for people who are only at average risk of bowel cancer (RACGP 2018). Instead, a FOBT is the preferred screening method for these people (Healthdirect 2020).
Only 2 to 5% of the population has an above-average risk of bowel cancer. A comprehensive overview of bowel cancer risk categories can be found in the RACGP’s Guidelines for Preventive Activities in General Practice.
Prior to the procedure, the patient will need to clear out their bowels. This is known as bowel preparation.
Bowel preparation may involve:
(ACSQHC 2020; Healthdirect 2020)
Bowel preparation should only be directed by a medical practitioner or appropriately trained clinician. When changes to medicines are considered, the patient should be closely observed.
The procedure itself takes about 25 to 45 minutes. The patient is positioned onto their left side and sedated before the colonoscope is inserted. The colonoscope is guided to the terminal ileum (the end of the colon where it meets the small intestine), then slowly withdrawn so that the clinician can assess the colon lining. Throughout this process, air will be introduced in order to expand the colon for easier visualisation (Healthdirect 2020; Better Health Channel 2018; WebMD 2019).
If polyps are found, they will be removed and sent to pathology for further examination (ACSQHC 2020).
Following the procedure, the patient may experience:
(Better Health Channel 2018; Healthdirect 2020)
(Healthdirect 2020; RACGP 2018)
In 2020, the Australia Commission on Safety and Quality in Health Care released the Colonoscopy Clinical Care Standard. This standard aims to ensure that colonoscopies are safe, appropriate and high-quality (ACSQHC 2019).
The standard contains nine quality statements:
A healthcare professional referring patients for colonoscopies should provide a comprehensive referral. This will allow receiving clinicians to assess whether a colonoscopy is appropriate for each patient.
The referral should include:
Colonoscopy appointments should be allocated based on patients’ clinical needs.
Patients should be assessed for colonoscopy suitability using national evidence-based guidelines and colonic disease epidemiology. Clinicians should take into account:
Patients should be provided with clear, comprehensive information about the procedure detailing:
Patients must give informed consent prior to the procedure.
Bowel preparation should be prescribed to patients based on:
Ensure patients understand the purpose of bowel preparation, how and when to use it and what the potential side-effects are. Patients should also be advised of any required medicine changes they need to make while undergoing bowel preparation.
It is recommended that patients use a split-dose regimen (where consumption of the bowel preparation is split between the night before the procedure and the morning of the procedure).
Patients should be sedated before the colonoscopy. In order to identify any potential risks associated with sedation (such as cardiovascular, respiratory or airway compromise), the clinician should assess the patient’s:
If any risks are identified, patients should be supervised by an anaesthetist or another appropriately-trained practitioner during the procedure.
Sedation and colonoscopies must be performed by appropriately-qualified clinicians with the required credentials.
When performing a colonoscopy:
Prior to discharge, patients should be informed about:
Once meeting discharge criteria, patients should be discharged into the care of a responsible adult with discharge instructions detailing postoperative care and when to resume regular activities (ACSQHC 2020).
Immediately following the procedure, patients should generally refrain from:
Patients should also be advised on what to do if they experience postoperative complications such as:
Patients should be provided with the results of the procedure, along with any follow-up recommendations. If prompt intervention or treatment is required, arrangements should be made and communicated.
Question 1 of 3
How should patients be positioned during a colonoscopy?
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