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  • • Chronic diarrhea.

    • Lower gastrointestinal bleeding.

    • Abdominal pain.

    • Evaluation of radiographic abnormalities.

    • • Ulcerations.

      • Filling defects.

      • Strictures.

    • Initial diagnosis and follow-up evaluation of inflammatory bowel disease.

    • Removal of foreign bodies.

    • Dilatation of colonic strictures.

    • Diagnosis and removal of polyps.

    • Histopathologic evaluation of pinhead-sized biopsy specimens.

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Absolute

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  • • Cardiorespiratory collapse.

    • Hemodynamically unstable patient.

    • Unstable airway.

    • Intestinal perforation.

    • Peritonitis.

    • Cervical spine trauma.

    • Toxic, fulminant colitis.

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Relative

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  • • Coagulopathy (prothrombin time > 18 sec).

    • Thrombocytopenia (platelet count < 100,000/μL).

    • Intestinal tract surgery within previous month.

    • Food intake within previous 6 hours.

    • Bowel obstruction.

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  • • Fiberoptic or video endoscopes.

    • Biopsy forceps.

    • Snares.

    • Nets and baskets.

    • Heater probes.

    • Electrocautery probes and snares.

    • Balloon-dilation devices.

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  • • Anesthesia complications.

    • Bleeding.

    • Perforation.

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  • • Biopsies are required because characteristics of many disorders may only be detectable under the microscope.

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  • • Obtain medical history and physical examination for clearance from pulmonary, cardiovascular, and hematologic standpoints.

    • Obtain laboratory tests, if needed.

    • • Hemoglobin levels.

      • Platelet count.

      • Prothrombin time.

      • Partial thromboplastin time.

    • Primary care providers can prepare patients and families by explaining that the colonoscopy provides detailed diagnostic information and rarely causes complications (1/2000 chance of significant bleeding or perforation).

    • Have parents sign a consent form.

    • Bowel preparation.

    • • Clear liquids for 24 hours prior to procedure (infants: 12 hours); avoid red-colored fluids.

      • Sodium phosphate, magnesium citrate, MiraLax (for 4 days), polyethylene glycol (PEG) lavage solution, enemas (saline or phosphate) if needed.

      • No oral intake after midnight before procedure.

    • Antibiotics for endocarditis prophylaxis in at-risk patients.

    • Antibiotics for immunosuppressed patients or those with central lines (controversial).

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  • • Left lateral decubitus.

    • Supine.

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  • • The colon is divided into 5 sections:

    • • Sigmoid.

      • Descending.

      • Transverse.

      • Ascending.

      • Cecum.

    • The rectum as well as the sigmoid and descending colon are the areas where juvenile polyps and ulcerative colitis are commonly seen.

    • The junction between the descending and transverse colons is usually marked by the bluish blush of the spleen.

    • The transverse colon can be recognized by the triangular-shaped folds.

    • The junction between the transverse and ascending (or right colon) is usually marked by the bluish blush of the liver.

    • The cecum can be verified by finding the small appendiceal opening, the ileocecal valve, or seeing light transilluminate the right lower quadrant.

    • The cecum and terminal ileum are often involved in Crohn disease.

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  • • Administer oxygen by nasal cannula.

    • Start intravenous sedation or gas anesthesia via an endotracheal catheter.

    • • Heavier sedation is required for colonoscopy than for upper endoscopy.

      • Sedation options include midazolam plus fentanyl for conscious sedation, but it is rarely sufficient for full colonoscopy; propofol; and general ...

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