General

Core DX Study

Synonym/Acronym:
full colonoscopy, lower endoscopy, lower panendoscopy.

Rationale
To visualize and assess the lower colon for tumor, cancer, and infection.

This Core Diagnostic Study is one of the most commonly requested diagnostic procedures; approximately 70% of people 50–75 years of age reported adhering to colon cancer screening guidelines. Colon cancer is one of the top causes of death in the United States; 25%–35% of colon cancer cases are familial, although specific gene sequence variations have not been identified. Specific gene sequence variations that demonstrate inherited colon cancer and Lynch syndrome have been identified and are relatively rare at 5%–10% of cases. Other examples of inherited cancer syndromes include breast and ovarian cancer.

Patient Preparation
Inform the patient that a laxative and cleansing enema may be needed the day before the procedure, with cleansing enemas on the morning of the procedure, depending on the institution’s policy. Instruct the patient that to reduce the risk of aspiration related to nausea and vomiting, solid food and milk or milk products are restricted for at least 6 hr, and clear liquids are restricted for at least 2 hr prior to general anesthesia, regional anesthesia, or sedation/analgesia (monitored anesthesia). The patient should omit drinking red-colored fluids that could interfere with study results. The patient may be asked to be NPO after midnight. The American Society of Anesthesiologists has fasting guidelines for risk levels according to patient status. More information can be located at https://pubs .asahq.org/anesthesiology/article/126/3/376/19733/.

Regarding the patient’s risk for bleeding, the patient should be instructed to avoid taking natural products and medications with known anticoagulant, antiplatelet, or thrombolytic properties or to reduce dosage, as ordered, prior to the procedure. The number of days to withhold medication is dependent on the type of anticoagulant. Note the last time and dose of medication taken.

Patients on beta blockers before the surgical procedure should be instructed to take their medication as ordered during the perioperative period. Protocols may vary among facilities.

Normal Findings

• Normal intestinal mucosa with no abnormalities of structure, function, or mucosal surface in the colon or terminal ileum.

Critical Findings and Potential Interventions
N/A