Generality
Pancolonscopy is an examination of the endoscopic intestine, that is performed from the inside of the organ, which allows its direct view of its walls. The purpose of this survey is to ascertain the causes of various types of symptoms, attributable to diseases of the digestive system, and / or to identify any anomalies (inflamed tracts, ulcerations, polyps, etc.).
Specifically, pancolonscopy allows visualization of the internal walls of the large intestine in all its features, until it reaches, when possible, the last section of the small intestine.
In the same way as colonoscopy, the examination involves the introduction, through the anal orifice, of a videoendoscope, which is slowly raised up through the loops of the intestine; the substantial difference lies in the size of the probe, which is longer and more flexible in pancolonscopy.
The procedure is aimed at investigating, therefore, the pathologies of the intestine, from chronic inflammatory diseases to tumors. In addition to providing diagnostic support, pancolonscopy can also be used to remove lesions (such as intestinal polyps) and / or take tissue samples .
Intestine: signs of anatomy
The intestine is the last part of the digestive system. Its appearance is that of a large pipe or duct, over ten meters long and divided into two sections:
- LITTLE INTESTINE, consisting of duodenum, jejunum and ileum;
- LARGE INTESTINE, formed by blind, colon, rectum and anus. The colon is subdivided, in turn, into the ascending, transverse, descending and sigmoid tracts.
The main function of the intestine consists in the absorption of food, now broken down into their simplest components, useful for nutritional purposes. This organ is also a vehicle for endocrine hormonal messages that regulate functions such as motility and intestinal secretions.
Pancolonscopy allows the exploration of the inside of the large intestine, until reaching, when possible, the last portion of the small intestine.
What's this
Pancolonscopy is an exam that allows to observe the internal walls of rectum, colon and caecum. This investigation is aimed at the diagnosis of possible diseases and the definition of the most suitable therapy.
To visualize the intestine, pancolonscopy uses a thin and flexible fiber optic probe, equipped with a tiny video camera at the apex. This instrument has external controllable mobility and transmits images to a monitor, which is observed by the operating doctor during the examination.
The endoscopic probe is inserted through the anus, after lubrication, then it is traced backwards in the rectum and in the other tracts of the large intestine, to evaluate in order:
- Sigmoid colon (or sigma);
- Descending colon;
- Transverse colon;
- Ascending colon;
- Blind.
In some cases, the last part of the small intestine (ie the one bordering on the cecum) can be reached and visualized with pancolonscopia, except that the anatomical conformation of the organ allows it (note: a long and tortuous intestine can not be fully explored).
Why do you run
Pancolonscopy is aimed at assessing possible bowel diseases : the doctor can make the diagnosis based on the appearance of intestinal walls or on the finding of specific lesions.
This exam allows to clarify the nature of symptoms and problems related to the digestive system and contributes to the definition of the most suitable therapy .
At the same time, pancolonscopy allows you to perform:
- Biopsies, that is taking small tissue fragments to be sent to the laboratory for microscopic histological analysis;
- Small surgical procedures, such as the removal of an intestinal polyp.
What are intestinal polyps?
Intestinal polyps are growths, similar to small cauliflowers, that develop on the wall of the intestine, especially in the colon-rectum. Although these lesions are mostly benign in nature, some of them may slowly evolve into a malignant tumor.
Being able to identify many of these precancerous lesions, pancolonscopy is useful in a preventive perspective.
When do you run?
Pancolonscopy is used to investigate bowel diseases, from chronic inflammatory diseases to polyps, up to tumors.
Usually, complete exploration of the intestine is reserved for ascertaining the causes of particular symptoms, including:
- Abdominal pains not otherwise explained;
- Sudden constipation;
- Long-lasting diarrhea;
- Significant drop in weight;
- Blood loss, visible in the stool.
Pancolonscopy is also used to identify the presence of any colon cancer in people at greater risk, that is, in the case where there are reasonable suspicions that this problem may have developed. The survey is also considered when the presence of numerous polyps is found or there is a family predisposition to bowel cancer .
Variants of pancolonscopy
The prefix "pan-" derives from the Greek and means "all, entirely": the pancoloscopy is understood, therefore, as the examination of all the features of the large intestine (rectum, sigma, descending colon, transverse colon, ascending colon and blind), sometimes reaching the small.
The variants of pancolonscopy are:
- Colonoscopy : is the reference exam, used for the screening and diagnosis of diseases affecting the entire colon;
- Rettosigmoidoscopy (or sigmoidoscopy): it analyzes only the last 50-60 cm of the intestinal tract, consisting of the rectum and the final part of the colon (sigma);
- Rectoscopy : is limited to the endoscopic exploration of the rectum.
In all these types of investigations, including pancolonscopy, the doctor can not only make the diagnosis based on the appearance of the intestinal walls, but can also take fragments of the mucosa (biopsy), on which histological examinations will subsequently be performed.
How to do it
Before pancolonscopy
Pancolonscopy takes place with a minimum of sedation, which allows the patient to better withstand the examination, while remaining conscious. The eventual discomfort can be determined above all from the introduction of air through the endoscopic instrument, which can provoke abdominal cramps and stimulus to "evacuate" .
During the exam
The patient is made to lie on the left side, with the thighs flexed on the pelvis and the knees bent.
Pancolonscopy is then performed by introducing, through the anal canal, a thin, long and flexible tube ( endoscopic probe ). At its end, this instrument is equipped with a light source and a tiny video camera, which allows to examine the alterations of the inner walls of the intestine on a special monitor . Thanks to this device it is also possible to perform a recording and / or take pictures of the areas of interest during the examination.
During pancolonscopy, the endoscopic probe is progressed gently along the entire large intestine; the progress can be manual or, in more recent models, robotic.
During the examination, air is blown through the instrument, so as to stretch the walls of the colon and better explore the intestine.
In the event that suspected lesions (not necessarily indicative of a cancer) are found, the doctor may decide to take small portions of tissue for examination ( biopsy ). During pancolonscopy, polyps can also be removed directly; it should be remembered that these protuberances are mostly benign in nature, but over time, if left in place, they could degenerate into malignant tumors.
How long does it last?
The duration of pancolonscopy depends on the patient's collaboration, on the "favorable" anatomical conformation of the part of the intestine explored and on the need to perform small interventions, such as the removal of a polyp. Indicatively, it takes at least 30-45 minutes .
At the end of the exam, the patient is discharged within an hour. However, if polyps have been removed, an observation period of a few hours may be necessary.
After pancolonscopy
After discharge, if the pancolonscopy was performed under sedation, it is clearly not recommended to drive the car to return to your home; better to be accompanied or use public transport. In addition, the patient should avoid performing other potentially dangerous activities in the following hours, such as driving machinery or other activities that require special attention.
Minor discomforts, such as the presence of gas or mild intestinal spasms may also occur after pancolonscopy. Full recovery will take place completely from the following day.
Preparation
- Pancolonscopy is not a painful investigation, but can be quite annoying, due to the anatomical conformation of the intestine and the air blown through the instrument, in order to stretch the bowel and facilitate the progression of the probe. To make the examination less unpleasant, sedatives can be administered to the patient, especially if the latter is an anxious subject and / or not prone to collaboration.
- For the result of pancolonscopia to be reliable, the intestine must be completely empty . Given that any faecal residues can cover the mucosa, hiding the alterations, colon cleansing is, to say the least, fundamental for an optimal observation of the features to be evaluated. In this regard, there is a specific preparation, which is indicated at the time of exam booking: the patient must strictly follow these instructions. In fact, poor intestinal cleansing can lead to postponement of the examination.
- In the 2-3 days preceding the pancolonscopia, a diet to follow is suggested; this regime mainly involves the removal of foods rich in fiber, such as fruit, vegetables and whole foods. The day before you should only take liquids, to be associated with the purgative indicated by your doctor. The latter generally consists of a liquid preparation that stimulates bowel movement and allows the colon to be cleaned from faeces residues. In some cases, the use of other laxative preparations or an enema may be required.
- Before pancolonscopy, it is absolutely necessary to report to the doctor any allergies, previous reactions to drugs and ongoing drug treatments .
Contraindications and Risks
Complications and possible side effects
Pancolonscopy is an overall safe procedure, but like all invasive procedures, it is not immune to complications.
- The most serious risk, fortunately very rare, concerns intestinal perforation . In practice, the accidental rupture of the organ wall could occur with the instrument used for pancolonscopy; in these cases, immediate repair surgery is required.
- Another complication, less serious, is related to performing biopsies or polypectomies. These procedures can cause bleeding, which can be stopped already during pancolonscopy.
- There is a risk of unwanted reactions to sedative or analgesic drugs . For this reason, before the start of the exam it is advisable to inform the doctor about any allergies or pharmacological treatments in progress.
- Some predisposed patients could also have cardio-respiratory or infectious complications, even after a few days from the exam.
Warning! In the days following pancolonscopia, in case of abdominal pain, fever and red blood loss from the anus, you should contact your doctor immediately or, alternatively, an emergency room.
Contraindications to pancolonscopy
Contraindications to pancolonscopy include acute diverticulitis and toxic megacolon (sudden dilation of the colon on an inflammatory basis).
To avoid causing intestinal perforation, this test should not be performed in the presence of deep ulcerative lesions, as can happen, for example, in patients with Crohn's disease .
More generally, pancolonscopy should not be performed immediately after a heart attack or after surgery on the abdomen .
Other "special" situations, in which the doctor will establish the safety and the actual necessity of the investigation, are represented by:
- Severe heart disease or respiratory disorders;
- Diseases that predispose to bleeding, such as liver cirrhosis and dysfunctions of coagulation and platelets;
- Diabetes;
- Suspicious or ascertained pregnancy;
Finally, it is advisable to consult with the doctor on the appropriateness of suspending any therapies with anticoagulant or antiplatelet drugs, in the event of having to remove polyps during pancolonscopy.
Interpretation of Results
Diagnostic Pancolonscopy
Pancolonscopy identifies the following conditions:
- Inflammation;
- ulceration;
- diverticula;
- Vascular anomalies;
- Narrowings (stenosis);
- Polyps;
- Neoplasms.
If necessary, pancolonscopy also allows biopsy of the mucosa to be performed, thanks to small forceps introduced through the endoscope. The samples thus taken will then be sent to the laboratory to be studied under a microscope; in this way they will help the doctor in the diagnosis of inflammatory bowel diseases and in ascertaining the benign or malignant nature of a suspected lesion.
Operative or "therapeutic" pancreas
Besides the important diagnostic role, pancolonscopy can become therapeutic. The procedure allows, in fact, to perform small interventions, including the management of hemorrhages and dilation of strictures, by introducing special accessories through the endoscope.
In the case of intestinal polyps (polypectomy) a particular electric scalpel is used, in the shape of a loop, which removes the lesion, burning its base. The polyp will then be recovered and examined in the laboratory to ascertain its benign or malignant nature.
In some cases, pancolonscopy manages to avoid subsequent surgery; other times, it allows to establish, with greater precision, the therapeutic path to follow.
Alternatives to pancolonscopy
In recent years, other ways of looking at the inside of the intestine have been developed. These include:
- Endoscopic videocapsule. Capsular endoscopy is a non-invasive diagnostic test recently introduced in the medical field, which allows the study of the intestine by means of a video capsule of the size slightly larger than a medical tablet. The endoscopic capsule contains a light source and a small camera; during the procedure, this is swallowed by the patient and, like any other pill, passes through the stomach and reaches the intestine, capturing thousands of images. These are sent to a device and, after about 8 hours, can be downloaded to the computer and examined by the doctor. Capsular endoscopy is particularly useful in patients with occult gastrointestinal bleeding.
- Virtual colonoscopy. Considered a modern alternative to pancolonscopy, virtual colonoscopy uses a special computerized tomography that simulates a traditional endoscopy. The virtual colonoscopy reproduces three-dimensional and two-dimensional high-resolution images of the internal surfaces of the colon, in real time. This examination is performed without the introduction of any endoscopic probe, but only requires a small cannula to blow the air; the virtual colonoscopy is, therefore, better accepted by the patient. However, compared to pancolonscopy, accuracy is slightly lower and this technique can only be used as a diagnostic tool. In fact, virtual colonoscopy does not allow biopsies to be performed or intestinal polyps to be removed, for which recourse to traditional techniques is still necessary.
