David J Phillips
M.B., B.S., F.R.C.S. (Ed) F.R.A.C.S.
SURGEON

COLONOSCOPY
Examination of large bowel

  Topics discussed:

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What is a Colonoscopy:
A colonoscopy is a relatively simple and painless procedure, which allows the doctor to examine the lining of the large bowel. A thin flexible tube is passed through the anus (back passage) to examine the lining of the rectum, large bowel (colon) and sometimes as far as the last part of the small bowel.

The doctor is able to look at the inside of these body parts by the use of a micro video camera which relays the pictures onto a television monitor. Photographs and biopsies can be taken for further examination by a pathologist. Likewise most polyps can be removed for pathological examination. It is quite common for the polyps to become small cancers as the polyps grow and enlarge and change with time.
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Why have a Colonoscopy:
There a number of reasons why patients should undergo a colonoscopy, particularly if it has been recommended by your general practitioner. It is also important to be aware of the signs you should tell your doctor about, so he can decide if a colonoscopy should be undertaken.

The most common reasons to undergo a colonoscopy are:
  1. To exclude conditions which may develop into bowel cancer. Bowel cancers often form in polyps, which commonly grow in the digestive tract. The polyps are sent to pathology for examination. This will show if they are of a pre cancerous type. If they are, the doctor will recommend you return at regular intervals for further colonoscopies. The time of these repeat colonoscopies will depend on the type of polyp diagnosed. Even if they are not of the pre cancerous type, you should probably have repeat colonoscopies about every five years as you are likely to grow further polyps.
  2. To investigate signs and symptoms which may suggest bowel cancer. There are a number of signs and symptoms, which may or may not be present in the person with bowel cancer. These include a change in bowel habit, such as diarrhoea or constipation, discoloured bowel motions or any sign of bleeding. A colonoscopy will examine the bowel for possible bowel tumours.
  3. To screen patients for cancer who have a family history of bowel cancer. If you have close relatives who have had bowel cancer, you are at a much higher risk of getting the disease. For this reason, it is usually recommended that you have a colonoscopy every five years once you have reached forty (40) years of age. In some cases where the prevalence of bowel cancer in the family is very high, your doctor may suggest you commence screening tests earlier.
  4. To diagnose other diseases of the bowel such as Ulcerative Colitis. In addition to polyps, which may develop into cancers, some patients suffer severe diarrhoea. This can sometimes be caused by a condition known as Ulcerative colitis. The lining of the bowel becomes irritated and forms ulcers. At colonoscopy, the doctor will biopsy the ulcers and then set about treating the condition. You may require follow-up colonoscopies to monitor how effective the treatment has been.
  5. To stop internal bleeding. Occasionally the patient may develop severe bleeding (haemorrhaging) from the inside the digestive tract. By passing instruments into the digestive tract, the doctor may be able to diathermy the blood vessels and stop the bleeding.
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Why is the removal of polyps so important:
Patients who have been found to have a polyp in the lower digestive tract are more likely to grow further polyps in the future. As polyps frequently develop into bowel cancers within the polyp it is important they are removed early. If the polyp is removed the risk of bowel cancer is reduced considerably.

It is quite common for the growth of polyps to be hereditary. Therefore if you have close relatives who are known to have had polyps removed, you should consider having a colonoscopy. Likewise if the doctor finds you have the condition of growing polyps, you may suggest to your close relatives that they have a colonoscopy.

This is a simple procedure which can prevent one of the major killers in our society, bowel cancer.
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How do I prepare for the colonoscopy:
For the doctor to view the lining of the bowel, the whole digestive tract must be emptied and cleaned thoroughly. As food can take a number of days to pass thorough the body, bowel preparation will take place over a period of time before the procedure (usually two to three days). First your diet will be restricted to low fibre foods and your instruction kit will advise which foods and how much you can eat in the days leading up to your colonoscopy. Finally the doctor will give you a bowel cleaning solution which is drunk over a period of time. There are several different types and the doctor will give you the one most suitable for your age and medical fitness. You must follow the instructions on the packet carefully regarding the dietary requirements and when you must drink the bowel cleaning solution. Note that the instructions change slightly depending on the time of day you are having your colonoscopy. As you need to ‘fast’, prior to the colonoscopy, it is easier to have the colonoscopy in morning rather than the afternoon.
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What is a Colonoscopy Preparation Kit:
So that the doctor may have a clear view of the inside of your body it is most important that is has been emptied of all food material and faeces. Prior to the colonoscopy the doctor will give you at the consultation a Colonoscopy Preparation Kit. If you are not having a consultation prior to the colonoscopy, the receptionist will arrange for you to collect the kit from one of Dr Phillip’s consulting rooms.

There are several different types of Colonoscopy Preparation Kits, some of the more common are Fleet, ColonLYTELY and Glycoprep. The instructions for each kit is different and the doctor will chose the one most suitable for your age and medical fitness. It is most important that you follow the instructions with your kit carefully.
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What does ‘fasting’ mean:
‘Fasting’ means to take nothing by the mouth – no food and no drink.

Morning Colonoscopy: You must fast (nothing by mouth – no food, no drink) from midnight.
Afternoon Colonoscopy: Clear fluid only for breakfast and you must fast from 10 am.

If you are having a colonoscopy and gastroscopy, must should follow the instructions on the Colonoscopy Preparation Kit, but stop all fluids 2 hours prior to procedure.
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What will the anaesthetist do to assist in the procedure: The role of the anaesthetist is to give you a mild sedative prior to the procedure so that you won’t feel the instrument passing through your digestive tract. He will briefly discuss your medical condition and explain the role of the anaesthetist while you are in hospital and just prior to your undergoing the procedure. He will stay with you after the procedure and ensure you wake up safely.
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After the Colonoscopy:
After waking you will feel a bit drowsy. The clinic will expect you to rest for an hour or two before allowing you to go home. You may feel a little bloated because air may have passed into your digestive tract and this will subside as the air passes through your body.

If a biopsy has been taken or a polyp removed these will be sent to the pathologist for examination. The results will not be known for a couple of days.

You must arrange to have someone escort you home. Under no circumstances can you drive a car or operate machinery for twenty-four hours. You should avoid alcohol for twenty-four hours. It is also recommended you should not sign any important documents for twenty-four hours.
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Where Does Dr Phillips Perform this procedure (Colonoscopy):

  • Brisbane Gastroscopy & Colonoscopy
    Level 2, 35 Astor Tce
 Spring Hill, 4000
  • Wesley-Turrawan Hospital
    641 Sandgate Road
Clayfield, 4012
  • Sunnybank Private Hospital
    245 McCullough Street
 Sunnybank, 4109
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How do I arrange to have my Colonoscopy:
You need to visit your general practitioner for a referral to a specialist. After reviewing your signs and symptoms your doctor may recommend a colonoscopy as a further means of diagnosing your condition. Your GP may wish you to visit Dr Phillips prior to the procedure for further advice and explanation or he may simply suggest you ring Dr Phillips’ rooms and arrange for the procedure to be performed. In either case you must book the appointment or procedure only through Dr Phillip’s Office:
Phone 3839 6507.
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What fees will be incurred for the Colonoscopy:
Dr Phillips accepts GapCover payments for all patients covered by Private Health Fund insurance participating in the scheme. All other patients are charged the same rate as the MBF Schedule fee. A considerable discount is given to pensioners, health care card holders and patients with no private health insurance if they have the procedure performed at Brisbane Gastroscopy & Colonoscopy.

If the doctor removes a polyp during the colonosocpy, the procedure will be called Colonoscopy with polypectomy (Medicare Item No 32093 rather than the colonoscopy Medicare Item No 32090). This will result in higher fees for the theatre, surgeon and anaesthetist.

For an estimation of total costs you can E-mail us or discuss this with the staff when you make your booking. However the following explains the various accounts and fees from both Dr Phillips and other associated service providores.

  • Brisbane Gastroscopy and Colonoscopy has government approved ‘simplified billing’. This means they will collect all fees not covered by your Health Fund and Medicare. This includes the theatre fees for the Endoscopy Centre, Dr Phillip’s (the endoscopist) and the anaesthetist when you arrive for the procedure. If you have a biopsy, the Pathologist will send you a separate account. If you have GapCover approved Private Health Insurance you will have no out of pocket expenditure. If you have no private insurance Brisbane Gastroscopy and Colonoscopy offers the lowest cost procedure of all the centres Dr Phillip’s attends and it is strongly recommended you take advantage of these lower fees. Please note you must book your procedure through Dr Phillip’s office and not Brisbane Gastroscopy and Colonoscopy.
 
  • Wesley-Turrawan Hospital. You will receive separate accounts from the Dr Phillips, the anaesthetist, the hospital and the pathologist (if required):
  1. Dr Phillips: If you have GapCover approved Private Health Insurance Dr Phillips will bill the heath fund direct and you will have no out of pocket expense. If you have no private health insurance you will be billed at the same rate as the MBF Schedule fee. You will receive a Medicare rebate of 75% of the Medicare Schedule fee.
  2. The Anaesthetist: This doctor’s fee structure is completely different to Dr Phillips and when the operation has been booked you will need to contact the particular doctor to discuss their fee. However Dr Phillips does have an understanding with anaesthetists on his regular lists, that those people covered by GapCover will have their account sent directly to the Health Fund and they will incur no out of pocket expenditure.
  3. The Hospital: If you have private health insurance you should contact your health fund to find what, if any, costs you will incur at that hospital for this procedure (Colonosocopy Medicare Item No 32090). If you do not have private hospital insurance you should contact the hospital regarding fees. You should advise the hospital if you are on a FULL PENSION.
  4. The Pathologist: Normally the company will be QML or Sullivan and Nicolaides. The pathologist is only required if a biopsy is taken.
 
  • Sunnybank Private Hospital You will receive separate accounts from the Dr Phillips, the anaesthetist, the hospital and the pathologist (if required):
  1. Dr Phillips: If you have GapCover approved Private Health Insurance Dr Phillips will bill the heath fund direct and you will have no out of pocket expense. If you have no private health insurance you will be billed at the same rate as the MBF Schedule fee. You will receive a Medicare rebate of 75% of the Medicare Schedule fee.
  2. The Anaesthetist: This doctor’s fee structure is completely different to Dr Phillips and when the operation has been booked you will need to contact the particular doctor to discuss their fee. However Dr Phillips does have an understanding with anaesthetists on his regular lists, that those people covered by GapCover will have their account sent directly to the Health Fund and they will incur no out of pocket expenditure.
  3. The Hospital: If you have private health insurance you should contact your health fund to find what, if any, costs you will incur at that hospital for this procedure (Colonoscopy Medicare Item No 32090). If you do not have private hospital insurance you should contact the hospital regarding fees. If you do not have Private Health Insurance you will find the cost at this hospital the dearest of the three options.
  4. The Pathologist: Normally the company will be QML or Sullivan and Nicolaides. The pathologist is only required if a biopsy is taken.
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