What is colonoscopy?

Colonoscopy is a procedure that examines the colon and rectum [Figure 1].  A thin flexible tube with a tiny video camera at the tip is inserted through the anus and advanced all the way into the first portion of the colon called cecum [Figure 2].  In some situations, the terminal ileum (the last portion of the small intestine is viewed).  The procedure is performed to check for conditions such as inflammation, ulcerations, infection, polyps, and tumors.  The procedure is performed in the endoscopy suite by Dr. Maher Abbas.   The procedure takes 20 minutes or longer depending on the condition of your child.  It is usually performed under intravenous sedation with medications.  During the procedure, small pieces of the lining of the digestive tract (biopsies) can be taken for evaluation under the microscope.  If polyps are encountered they are either removed or biopsied.

When your child arrives at the endoscopy suite, you will meet a nurse who will briefly review his/her medical history.  Your child will change into a hospital gown and have his/her vital signs measured and an intravenous (IV) line placed in his/her arm.  This IV line will be used to provide sedating medications during the procedure.    Your child will be taken on a stretcher to the procedure room and the procedure will be performed by Dr. Maher Abbas while you wait in the family waiting area.  Your child blood pressure, heart rate, oxygen, and breathing will be monitored safely during the entire procedure.

Figure 1 – Colonoscopy

Figure 2 – Colonoscope

What are the risks of colonoscopy?

Colonoscopy is a safe procedure and Dr. Maher Abbas has performed thousands of endoscopic procedures.  Minor risks include transient dizziness, medication reaction, nausea, abdominal discomfort with bloating and gas.  Major complications are extremely rare and consist of bleeding or perforation (a small hole) which is usually treated endoscopically but on rare occasions can require hospitalization and another endoscopic or surgical procedure.

How do you prepare your child for the procedure?

It is very important to follow the instructions in order to thoroughly cleanse the intestine.  This improves the quality of the procedure and allows Dr. Maher Abbas to perform a high-quality examination.  A poor preparation can lead to suboptimal examination with possible cancellation and the need to repeat the procedure.

If your child has severe constipation (has a bowel movement less frequently than twice a week), ask Dr. Maher Abbas for further instructions as additional medications and/or enemas will be given for a better preparation. 

Step 1 – When you schedule your child’s colonoscopy

Pick up the medications from pharmacy ahead of time.

If your child takes medications for diabetes, blood thinners, aspirin, or non-steroidal anti-inflammatory medications (medications used for pain, arthritis, or headaches, such as ibuprofen, naproxen, diclofenac, ericoid), or has a heart condition, let Dr. Maher Abbas and his nurse know at the time when you book the procedure.

Stop any iron (including multivitamins with iron), 1 week prior to colonoscopy.

Step 2 – Two days before the colonoscopy

Your child can eat but avoid foods that are difficult to digest such as nuts, seeds, bran, popcorn, all vegetables, fruits, and salads.

Step 3 – On the day prior to the colonoscopy

Starting at 8:oo am (morning), your child should begin a clear liquid diet for breakfast and lunch [see below diet].   NO SOLID FOOD or thick liquid the day prior to colonoscopy.

At 2:00 pm give your child 1 Dulcolax 5 mg tablet.  At 3:00 pm (afternoon), begin the Klean-Prep^®.  Dissolve 1 sachet of the Klean-Prep^® in 1 liter of water.  Administer at a rate of about 100 ml every 10-15 minutes so that the 1 liter mixture is taken over 2 hours.  You can flavor with apple juice or white grape juice.  If Dr. Maher Abbas has prescribed additional sachets, repeat as instructed.    At 7:00 pm give your child another Dulcolax 5 mg tablet.  After the preparation is done your child can drink water, apple juice, white grape juice, light tea, black coffee, and carbonated beverages until 6 hours prior to the procedure.

CLEAR LIQUIDS

The type of liquids you can see light through such as: water, clear fruit juices (apple, white cranberry, white grape), beef or chicken broth, ginger ale, carbonated beverages (Sprite, 7-UP, tea (no milk), Popsicles, and Jelly (no red colors or dyes).

Your child can have yogurt, plain ice cream, sherbet, honey, and syrups.

• Do not drink anything that has RED DYE (no red dyes)
• Do not eat solid foods
• Do not drink milk or creamers

Step 4 – On the day of your child’s procedure

Kindly arrive 1 hour prior to the scheduled time to avoid delays or possible cancellation of the procedure (Dr. Maher Abbas runs a busy and tight schedule).   Report to the admission desk.     The entire process can take up to 3-4 hours.  If your child takes medications for a medical condition, discuss with Dr. Maher Abbas if he/she can take with a small sip of water as soon as he/she gets up.

Post colonoscopy care

Activity

Immediately after the procedure, your child will rest for 30 to 60 minutes in the recovery area.  It is best to take the remainder of the day off school and rest at home.   He/she can resume usual activity and school the following day.  If biopsies are taken, avoid strenuous activity or vigorous exercise such as bicycle riding, jogging, weight lifting, or aerobic exercise for 1 week.

Diet

Once your child recovers from the sedative given during the procedure, he/she will receive a meal in the recovery area of endoscopy suite.  If he/she has nausea, it is best to remain on a liquid diet for the rest of the day.

Medications

Home medications can be resumed after the procedure.  If your child is on any blood thinner, ask Dr. Maher Abbas for specific instructions.  For abdominal discomfort, you can give your child the equivalent of 325 to 500 mg of acetaminophen (based on age) every 8 hours [panadol, paracetamol, tylenol].  Encourage your child to drink plenty of water and fluids after the procedure.

Signs to watch for

If biopsies are taken during the procedure, a very small amount of dark or streaks of fresh blood can be expected with the first bowel movements.  Colonoscopy is a safe procedure.  If any of the following symptoms occurs, contact Dr. Maher Abbas’ office and bring your child to the emergency department immediately:

• Chest pain, racing heart beats, or shortness of breath
• Fever with Temperature >38 ° Celsius, >100.4 ° Fahrenheit
• Persistent nausea, vomiting
• Persistent rectal bleeding with clots or bright blood
• Redness and pain at the medication injection site
• Severe abdominal pain with distention or continuous spasm

Follow-up appointment

The proper follow-up appointment will be scheduled.  If medications are prescribed, pick up from the pharmacy and give to your child as instructed.  If biopsies are taken, the results will usually become available within a week.

Any questions?  Contact Dr.  Maher A. Abbas’ office nurse here.