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Colonoscopy is one of the colorectal cancer screening tests available to people in the US who are 45 years of age and older. The other screening tests include [[flexible sigmoidoscopy]], [[double-contrast barium enema]], [[virtual colonoscopy|computed tomographic (CT) colongraphy]] (virtual colonoscopy), [[stool guaiac test|guaiac-based fecal occult blood test]] (gFOBT), [[fecal immunochemical test]] (FIT), and [[multitarget stool DNA screening test]] (Cologuard).<ref>{{cite web | title=Colorectal Cancer Prevention and Early Detection | url=http://www.cancer.org/acs/groups/cid/documents/webcontent/003170-pdf.pdf | pages=16–24 | publisher=[[American Cancer Society]] | date=February 5, 2015 | access-date=2015-12-25}}</ref>
Subsequent rescreenings are then scheduled based on the initial results found, with a five- or ten-year recall being common for colonoscopies that produce normal results.<ref>{{cite journal | vauthors = Rex DK, Bond JH, Winawer S, Levin TR, Burt RW, Johnson DA, Kirk LM, Litlin S, Lieberman DA, Waye JD, Church J, Marshall JB, Riddell RH
Among people who have had an initial colonoscopy that found no polyps, the risk of developing colorectal cancer within five years is extremely low. Therefore, there is no need for those people to have another colonoscopy sooner than five years after the first screening.<ref>{{cite journal | vauthors = Imperiale TF, Glowinski EA, Lin-Cooper C, Larkin GN, Rogge JD, Ransohoff DF | title = Five-year risk of colorectal neoplasia after negative screening colonoscopy | journal = The New England Journal of Medicine | volume = 359 | issue = 12 | pages = 1218–1224 | date = September 2008 | pmid = 18799558 | doi = 10.1056/NEJMoa0803597 | doi-access = free }}</ref><ref>[http://newswise.com/articles/view/544318/ No Need to Repeat Colonoscopy Until 5 Years After First Screening] Newswise, Retrieved on September 17, 2008.</ref>
Some medical societies in the US recommend a screening colonoscopy every 10 years beginning at age 50 for adults without increased risk for colorectal cancer.<ref name="coloscreen">{{cite journal | vauthors = Winawer S, Fletcher R, Rex D, Bond J, Burt R, Ferrucci J, Ganiats T, Levin T, Woolf S, Johnson D, Kirk L, Litin S, Simmang C
Colonoscopy screening is associated with approximately two-thirds fewer deaths due to colorectal cancers on the left side of the colon, and is not associated with a significant reduction in deaths from right-sided disease. It is speculated that colonoscopy might reduce rates of death from colon cancer by detecting some colon polyps and cancers on the left side of the colon early enough that they may be treated, and a smaller number on the right side.<ref name="Baxter09">{{cite journal | vauthors = Baxter NN, Goldwasser MA, Paszat LF, Saskin R, Urbach DR, Rabeneck L | title = Association of colonoscopy and death from colorectal cancer | journal = Annals of Internal Medicine | volume = 150 | issue = 1 | pages = 1–8 | date = January 2009 | pmid = 19075198 | doi = 10.7326/0003-4819-150-1-200901060-00306 | doi-access = free | url = http://www.media.dssimon.com/taperequest/acp50_study.pdf | archive-url = https://web.archive.org/web/20120118213536/http://www.media.dssimon.com/taperequest/acp50_study.pdf | archive-date=January 18, 2012 }}</ref>
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The large [[Randomized controlled trial|randomized]] [[pragmatic clinical trial]] NordICC was the first published trial on the use of colonoscopy as a screening test to prevent colorectal cancer, related death, and death from any cause. It included 84,585 healthy men and women aged 55 to 64 years in Poland, Norway, and Sweden, who were randomized to either receive an invitation to undergo a single screening colonoscopy (invited group) or to receive no invitation or screening (usual-care group). Of the 28,220 people in the invited group, 11,843 (42.0%) underwent screening. A total of 15 people who underwent colonoscopy (0.13%) had major bleeding after polyp removal.
None of the participants experienced a [[colon perforation]] due to colonoscopy. After 10 years, an [[Intention-to-treat analysis|intention-to-screen analysis]] showed a significant [[relative risk reduction]] of 18% in the risk of colorectal cancer (0.98% in the invited group vs. 1.20% in the usual-care group). The analysis showed no significant change in the risk of death from colorectal cancer (0.28% vs. 0.31%) or in the risk of death from any cause (11.03% vs. 11.04%). To prevent one case of colorectal cancer, 455 invitations to colonoscopy were required.<ref name="Bretthauer2022">{{cite journal | vauthors = Bretthauer M, Løberg M, Wieszczy P, Kalager M, Emilsson L, Garborg K, Rupinski M, Dekker E, Spaander M, Bugajski M, Holme Ø, Zauber AG, Pilonis ND, Mroz A, Kuipers EJ, Shi J, Hernán MA, Adami HO, Regula J, Hoff G, Kaminski MF
As of 2023, the CONFIRM trial, a randomized trial evaluating colonoscopy vs. FIT is currently ongoing.<ref>{{cite web|url=https://clinicaltrials.gov/ct2/show/NCT01239082|title=Colonoscopy Versus Fecal Immunochemical Test in Reducing Mortality From Colorectal Cancer (CONFIRM) - Full Text View - ClinicalTrials.gov|website=clinicaltrials.gov|access-date=2019-02-25}}</ref>
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===Perforation===
The most serious complication is generally [[gastrointestinal perforation]], which is life-threatening and requires immediate surgical intervention.<ref name=SartelliViale2013>{{cite journal | vauthors = Sartelli M, Viale P, Catena F, Ansaloni L, Moore E, Malangoni M, Moore FA, Velmahos G, Coimbra R, Ivatury R, Peitzman A, Koike K, Leppaniemi A, Biffl W, Burlew CC, Balogh ZJ, Boffard K, Bendinelli C, Gupta S, Kluger Y, Agresta F, Di Saverio S, Wani I, Escalona A, Ordonez C, Fraga GP, Junior GA, Bala M, Cui Y, Marwah S, Sakakushev B, Kong V, Naidoo N, Ahmed A, Abbas A, Guercioni G, Vettoretto N, Díaz-Nieto R, Gerych I, Tranà C, Faro MP, Yuan KC, Kok KY, Mefire AC, Lee JG, Hong SK, Ghnnam W, Siribumrungwong B, Sato N, Murata K, Irahara T, Coccolini F, Segovia Lohse HA, Verni A, Shoko T
===Issues from general anesthesia===
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===Preparation===
The colon must be free of solid matter for the test to be performed properly.<ref name="pmid25239068">{{cite journal | vauthors = Johnson DA, Barkun AN, Cohen LB, Dominitz JA, Kaltenbach T, Martel M, Robertson DJ, Boland CR, Giardello FM, Lieberman DA, Levin TR, Rex DK
The day before the colonoscopy (or [[colorectal surgery]]), the patient is either given a [[laxative]] preparation (such as [[bisacodyl]], [[phospho soda]], [[sodium picosulfate]], or [[sodium phosphate]] and/or [[magnesium citrate]]) and large quantities of fluid, or [[whole bowel irrigation]] is performed using a solution of [[polyethylene glycol]] and [[electrolytes]].<ref>{{cite journal | vauthors = Hung SY, Chen HC, Chen WT | title = A Randomized Trial Comparing the Bowel Cleansing Efficacy of Sodium Picosulfate/Magnesium Citrate and Polyethylene Glycol/Bisacodyl (The Bowklean Study) | journal = Scientific Reports | volume = 10 | issue = 1 | pages = 5604 | date = March 2020 | pmid = 32221332 | pmc = 7101403 | doi = 10.1038/s41598-020-62120-w | bibcode = 2020NatSR..10.5604H }}</ref><ref>{{cite journal | vauthors = Kumar AS, Kelleher DC, Sigle GW | title = Bowel Preparation before Elective Surgery | journal = Clinics in Colon and Rectal Surgery | volume = 26 | issue = 3 | pages = 146–152 | date = September 2013 | pmid = 24436665 | pmc = 3747288 | doi = 10.1055/s-0033-1351129 }}</ref> The procedure may involve both a pill-form laxative and a bowel irrigation preparation with the polyethylene glycol powder dissolved into any clear liquid, such as a sports drink that contains electrolytes.
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===Procedure===
[[File:Diagram showing a colonoscopy CRUK 060.svg|thumb|Schematic overview of colonoscopy procedure]]
During the procedure the patient is often given [[sedation]] intravenously, employing agents such as [[fentanyl]] or [[midazolam]]. Although meperidine (Demerol) may be used as an alternative to fentanyl, the concern of seizures has relegated this agent to second choice for sedation behind the combination of fentanyl and midazolam. The average person will receive a combination of these two drugs, usually between 25 and 100{{nbsp}}µg IV fentanyl and 1–4{{nbsp}}mg IV midazolam. Sedation practices vary between practitioners and nations; in some clinics in Norway, sedation is rarely administered.<ref>{{cite journal | vauthors = Bretthauer M, Hoff G, Severinsen H, Erga J, Sauar J, Huppertz-Hauss G | title = [Systematic quality control programme for colonoscopy in an endoscopy centre in Norway] | language = no | journal = Tidsskrift for den Norske Laegeforening | volume = 124 | issue = 10 | pages = 1402–1405 | date = May 2004 | pmid = 15195182 }}</ref><ref>{{cite journal | vauthors = Dossa F, Dubé C, Tinmouth J, Sorvari A, Rabeneck L, McCurdy BR, Dominitz JA, Baxter NN
The first step is usually a [[digital rectal examination]] (DRE), to examine the tone of the anal [[sphincter]] and to determine if preparation has been adequate. A DRE is also useful in detecting anal [[neoplasm]]s and the clinician may note issues with the prostate gland in men undergoing this procedure.<ref>{{cite journal | vauthors = Farooq O, Farooq A, Ghosh S, Qadri R, Steed T, Quinton M, Usmani N | title = The Digital Divide: A Retrospective Survey of Digital Rectal Examinations during the Workup of Rectal Cancers | journal = Healthcare | volume = 9 | issue = 7 | pages = 855 | date = July 2021 | pmid = 34356233 | pmc = 8306048 | doi = 10.3390/healthcare9070855 | doi-access = free }}</ref> The [[endoscopy|endoscope]] is then passed through the [[anus]] up the [[rectum]], the [[Colon (anatomy)|colon]] (sigmoid, descending, transverse and ascending colon, the cecum), and ultimately the [[ileum|terminal ileum]]. The endoscope has a movable tip and multiple channels for instrumentation, air, suction and light. The bowel is occasionally insufflated with air to maximize visibility (a procedure that gives the patient the false sensation of needing to take a [[bowel movement]]). Biopsies are frequently taken for [[histology]]. Additionally in a procedure known as [[chromoendoscopy]], a contrast-dye (such as [[indigo carmine]]) may be sprayed through the endoscope onto the bowel wall to help visualize any abnormalities in the mucosal morphology. A [[Cochrane review]] updated in 2016 found strong evidence that chromoscopy enhances the detection of cancerous tumors in the colon and rectum.<ref>{{cite journal | vauthors = Brown SR, Baraza W, Din S, Riley S | title = Chromoscopy versus conventional endoscopy for the detection of polyps in the colon and rectum | journal = The Cochrane Database of Systematic Reviews | volume = 2016 | issue = 4 | pages = CD006439 | date = April 2016 | pmid = 27056645 | pmc = 8749964 | doi = 10.1002/14651858.CD006439.pub4 }}</ref>
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== Further reading ==
{{refbegin}}
* {{cite journal | vauthors = Gupta S, Lieberman D, Anderson JC, Burke CA, Dominitz JA, Kaltenbach T, Robertson DJ, Shaukat A, Syngal S, Rex DK
* {{cite journal | vauthors = Gupta S, Lieberman D, Anderson JC, Burke CA, Dominitz JA, Kaltenbach T, Robertson DJ, Shaukat A, Syngal S, Rex DK
* {{cite journal | vauthors = Joseph DA, King JB, Dowling NF, Thomas CC, Richardson LC | title = Vital Signs: Colorectal Cancer Screening Test Use - United States, 2018 | journal = MMWR. Morbidity and Mortality Weekly Report | volume = 69 | issue = 10 | pages = 253–259 | date = March 2020 | pmid = 32163384 | pmc = 7075255 | doi = 10.15585/mmwr.mm6910a1 }}
{{refend}}
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