You scheduled your screening or surveillance colonoscopy, did the prep, and had the procedure done - congrats! Now you have a procedure report, and possibly a pathology (biopsy) report in hand. I have found that even with the proper explanations, many of my patients still have questions when they are looking over their results. My goal in this blog post is to explain some of the more common findings from screening colonoscopy, as well as some general recommendations regarding those results.
Colonoscopy findings we will review:
Before we dive in, a few things you want to note in your report that speak to how strong of an exam was accomplished:
Cleanliness of the prep (want to have "good" or "excellent")
Time of withdrawal (at least 6 minutes)
Photo documentation of the cecum (beginning of colon) or Terminal Ileum (final portion of the small intestine) - this documents that the full extent of the colon was reached.
I mention this in particular, as if any of the above were not accomplished (i.e., suboptimal prep, or anatomy did not allow for the scope to reach the cecum) the exam is more limited and your gastroenterologist may suggest a repeat colonoscopy in a shortened interval, or another exam to complete the evaluation.
I. Colon Polyps
The first thing to know about polyps is that not all polyps are created equal. The vast majority of smaller polyps are benign, but beyond whether or not they are benign is the question of "does this polyp harbor any cancer potential (i.e. pre-malignant, or pre-cancerous)? "
The most common benign polyps encountered are called:
Hyperplastic - NO cancer potential (with rare exception)
Tubular Adenoma/Villous Adenoma - most common pre-cancerous type of polyp
Sessile Serrated Polyp/Adenoma - these are also pre-cancerous, thought previously to be a sub-type of hyperplastic polyps that did in fact carry cancer potential
Your gastroenterologist should comment on the size, location, and number of polyps removed on your procedure report, and then the pathology report should help to correlate the type of polyp in order to make a recommendation regarding a time frame to repeat a colonoscopy.
The report may also mention the word "dysplasia" (an example would be "the polyp is a Tubular Adenoma without Dysplasia). If dysplasia is present, this means that the polyp is beginning to undergo changes towards cancer, but is not considered cancer until it undergoes a change to carcinoma.
If adenoma-type polyps are found and removed, your gastroenterologist is likely to recommend that in addition to a shortened surveillance interval, your first-degree relatives should get screened at an earlier age, with colonoscopy in particular.
Based on the size, number, and type of polyps, you should receive a recommendation for a time-frame to repeat your colonoscopy based on the AGA/ASGE/ACG guidelines for a repeat exam after polyps are found and removed. (reference below)
II. Diverticulosis and Diverticulitis
Diverticulosis are small pouches within the wall of the colon. These form in areas of muscular weakening, and are quite common. Often these are a consequence of chronic increases in colonic pressure, such as in patients with constipation.
Treatment of diverticulosis is aimed at decreasing that pressure by avoiding constipation. Dietary fiber, fiber supplements, and laxatives may be recommended.
Diverticulitis are when the pouches are inflamed or infected. Patients will typically present with abdominal pain and nausea, with or without fever. Your doctor may ask you to have a CT scan performed which often will show the inflammation and simultaneously evaluate for any complications (i.e. Complicated Diverticulitis) such as an abscess or perforation (hole in the colon wall) which may have occurred as a result of the diverticulitis episode.
Uncomplicated diverticulitis is treated with antibiotics and sometimes with bowel rest by altering the diet. Complicated Diverticulitis may require admission to a hospital for more aggressive care including bowel rest, IV antibiotics, and sometimes surgical intervention.
III. Internal Hemorrhoids
While you are under sedation for colonoscopy, this presents a good opportunity to carefully examine the inside of the rectum for Internal Hemorrhoids. In brief, Internal hemorrhoids are blood vessels originating inside the rectum, and are graded on a scale of 1-4. Based on the size, you may receive a recommendation for further treatment, and in my practice I will offer appropriate patients the option of Hemorrhoid Banding. For more information, and I have written a more detailed post previously here, which goes into further detail.
Hopefully this article provides you with the basics regarding common findings at colonoscopy. As always, your specific findings may vary, and there are many other results that may be found during your exam. Please feel free to use this article as a guide, but I encourage you to discuss your results with your doctor, so that you understand the findings and recommendations.
If you are a patient who is ready to schedule or has been recommended to have a colonoscopy, you can easily request an consultation with me by clicking on the Appointments page. Another option for individuals who have a relationship with a Primary Care Provider and are in good health is to request an Open Access Colonoscopy, and more information can be found on the Open Access Colonoscopy page.
DISCLAIMER: Please note that this blog is intended for Informational Use only and is not intended to replace personal evaluation and treatment by a medical provider. The information provided on this website is not intended as substitute for medical advice or treatment. Please consult your doctor for any information related to your personal care.