A colonoscopy is a procedure in which a thin, flexible tube with a camera on the end is inserted through the colon (large intestine) while you are asleep to look for and remove lesions. It has been available in the United States for over 50 years and has significantly advanced during that time. It is performed Monday through Friday at our gastroenterology clinic in San Antonio, TX.
When you arrive for your colonoscopy, our endoscopy nursing team will check you in, review your medical history, and place an IV to help make you comfortable during the procedure. You will then meet with the anesthesiology provider to discuss your sedation. Afterward, Dr. Havranek will review the procedure with you and answer any last-minute questions. The entire process takes about 20-30 minutes.
Once in the endoscopy suite, you will receive medication through your IV to make you sleepy and comfortable. You will be awake enough to breathe on your own but sleepy enough not to feel any discomfort during the exam. While you are asleep, Dr. Havranek will pass the colonoscope (a small, thin tube) along the inside of your colon until it reaches the small intestine on the other side (about 5-6 feet). Any polyps encountered will be removed at this time.
The procedure itself takes about 20-30 minutes, after which you will be taken to the recovery room to wake up gradually. Once you are awake (approximately 30-60 minutes later), Dr. Havranek will review the results of your exam with you before you go home, and you will receive a copy of the report for your records.
We will do everything possible to make your exam as safe, pleasant, and comfortable as we can. Please arrive at the endoscopy center at least one hour before your scheduled exam time. This allows our nurses and anesthesia providers to review everything with you in detail and discuss your health and medical history, ensuring your safety. They will also answer any questions you may have. An IV will be placed in a vein in your arm to administer fluids and medications during the procedure.
You will speak with Dr. Havranek, who will address any questions you have before the exam. Then, you will receive medications through the IV to help you relax and sleep during the procedure. You will be alert enough to breathe on your own but sleepy enough to feel comfortable. Once you fall asleep, we will insert the scope and examine your entire colon for abnormalities, taking biopsies or removing polyps as needed. This process takes about 20-30 minutes.
You will then be taken to the recovery room, where a different group of nurses will monitor you closely until you are fully awake. Dr. Havranek will review your exam results with you before you leave the endoscopy center that day, and copies will be sent to your doctor. Although you will be awake before you leave, it is important that you bring a friend or relative who can safely drive you home. You should take this day off work and will probably want to relax and rest for the rest of the day. The day after your exam, you can return to full activity.
Polyps are common. Studies have shown that about 25-40% of people over age 45 have a precancerous colon polyp during their exam. Most polyps can be removed during a colonoscopy. Dr. Havranek has many tools he can insert through the colonoscope’s working channels during your exam to safely remove them. For small polyps, he will use biopsy forceps, like small scissors, to trim them out. For larger polyps, he will use a snare (like a loop) that goes around the base of the polyp, and while cutting through it, an electric current is applied to cauterize the base and reduce bleeding. Since polyps grow in the colon’s superficial lining (mucosa), which has very few significant blood vessels, any bleeding is usually minimal and stops on its own within a minute or two. Polyps that are too large to be safely removed are biopsied and tattooed—meaning dye is injected into the lining of the colon at the site of the polyp for easy identification in the future. Once the biopsy results return, Dr. Havranek’s team will discuss the significance of the polyp and decide whether they can safely monitor it or have it removed surgically (laparoscopically). All removed polyps are sent to a gastroenterology-trained pathologist, who reviews them and provides a report on their type. That information, along with Dr. Havranek’s recommendations, is then sent to you through our patient web portal and faxed to your physician.
Yes. You will be sedated for the exam, so legally you cannot drive for 24 hours. You will need an adult you know (not a taxi or Uber driver) to be present at the end of your exam to take you home. They do not need to be there during your exam, and we can call them to pick you up when you’re finished. This policy is in place for your safety.
The day before your colonoscopy, you will start a liquid diet around lunchtime. You can continue to work on this day. That evening, usually after work, you will begin the bowel prep. This will keep you occupied for the night, so if you work the graveyard shift, you should take that shift off to stay at home. On the day of the exam, we ask that you take the entire day off work. Although you will only be at our endoscopy center for about 2-3 hours, you will be sedated, so we do not want you driving or making any major decisions for the rest of the day. You will likely want to go home and rest. The next day, you can return to your normal activities.
A patient’s privacy is always a top priority. Our team members understand that the idea of strangers seeing your bare skin can be embarrassing. We take extra precautions to keep you covered with warm blankets right up to your exam. Once you are asleep, Dr. Havranek will expose only the necessary part of your backside to safely pass the colonoscope and perform the colonoscopy. The nurse and anesthesiology provider work on the opposite side of your exam table and cannot see your backside. The endoscopy technician assisting Dr. Havranek during the procedure will stand by his side and conduct everything professionally. Our team will do everything possible to protect your privacy.
A colonoscopy performed by an experienced team should not be painful at all. Before the exam begins, you will receive some sedating medication through your IV administered by an anesthesia provider, and you will drift off to sleep. You will be awake enough to breathe on your own but sleepy enough to be comfortable. During the exam, you should not feel anything. Afterward, you may feel gassy and bloated for a while due to the air introduced into your colon during the procedure, but this usually passes fairly quickly.
The U.S. Preventive Services Task Force and the American College of Gastroenterology both recommend that colon cancer screening start at age 45. They also suggest ongoing surveillance until at least age 75, depending on other health factors. If you have additional risk factors, such as a family history of colon cancer or precancerous polyps (adenomas), a personal history of other cancers, or a hereditary condition linked to higher colon cancer risk, screening might need to begin at a younger age. Unexplained rectal bleeding at any age should also be evaluated. If you have specific questions about when to be screened, please contact our office to schedule an appointment to discuss your screening plan.
For the correct indication, colonoscopy is covered by most insurance carriers. Screening at age 45 or older, or sooner if you have risk factors, and blood in the stool, is also covered by nearly all insurance plans. The only sure way to know is to have our office check your insurance benefits, which they will do free of charge. They can determine if and how well it is covered under your plan. Don’t let your insurance company’s decision on coverage discourage you from getting screened—if colon cancer is missed, the insurance saves money on the colonoscopy, but you may have to deal with the cancer later. Most endoscopy centers, including ours, offer private pay cash prices if your insurance doesn’t cover your exam. Our goal is to make this affordable so you can get screened.
Yes. There are many studies on this topic, and we have found that colonoscopy and colon cancer screening do save lives. It is estimated that over 158k people will be diagnosed with colon cancer in the United States this year, and 55k will die from it. A large, long-term study from Harvard School of Public Health concluded that 40% of all colorectal cancers could be prevented if people underwent colonoscopy screening. The National Polyp Study conducted in the United States found risk reductions of 76% to 90% among those screened with colonoscopy. These are just two examples of many studies showing that colonoscopy effectively helps prevent colon cancer by finding and removing polyps, ultimately saving lives.
A colonoscope is a thin (10mm) tube with a lighted camera. It also has channels that allow different instruments, like small forceps for biopsies or snares to remove polyps, to be passed into your colon during the exam. This makes the colonoscope a tool that helps us both detect and remove polyps during the same procedure. It is used by gastroenterologists, like Dr. Havranek, to treat colon bleeding, remove polyps, detect colon cancer, and remove foreign objects.
The majority of the risks of treatment for colon cancer are associated with side effects of the medications. I will say that the risk of NOT treating colon cancer is higher than any of them. The main risks of surgery for colon cancer are bleeding and infection. There will likely be some degree of pain or discomfort afterwards as well. These things we can control with medication. If you require an ostomy bag after the operation there may be skin irritation and pain associated with that as well. If radiation is required for the colon cancer, it can cause radiation damage to the tissues and organs around the colon. This can cause scar tissue to develop which may lead to abdominal pain and it can cause radiation damage to the tissues that can result in bleeding later on. If you require chemotherapy there are many different side effects depending on which chemotherapy you get. Most common problems with chemotherapy are increased risk of infection, nausea and vomiting, diarrhea, hair loss and fatigue. We have medications available to help lessen most of those symptoms but sometimes they get bad enough that the chemotherapy has to be stopped.
In the unfortunate event that colon cancer is found in your colon on the exam, there are still options. The success of these options all depend on how early the cancer was detected, obviously the earlier the better. Most cancers, if caught in time, are still curable.
Once someone is diagnosed with colon cancer several things will happen. First, the cancer will be staged. What time means is, through a combination of biopsy, lab work and radiology studies I will determine if the cancer is localized (contained within that section of the colon only) or metastatic (has advanced through the wall of the colon into the blood supply, lymphatics or tissues beyond the colon). The majority of the time when colon cancer is detected early and is still localized it can be cured by surgical resection. During surgical resection, the colorectal surgeon will cut out the diseased section of the colon, many times laparoscopically, and then hook the colon back together without the need for an ostomy bag. You are then put on a surveillance program with colonoscopy to watch for recurrence.
If the colon cancer has already spread beyond the wall of the colon (metastatic) then treatment is more involved. Treatment for this is usually a combination of surgery to remove the disease section of colon and chemotherapy with radiation. The types of chemotherapy and decisions on which we use are beyond the scope of this blog but I want you to understand that the types of chemotherapy medications we have and the success of those medications have gotten a lot better over time.
I will start by saying most colon cancer and most all polyps are asymptomatic. Don’t wait until you develop symptoms to get checked. Having said that, if you develop colon cancer the symptoms can include blood in your stool, change in the frequency, consistency of size of your stool (pencil thin stool), abdominal or back pain, unexplained weight loss, weakness, fatigue and shortness of breath.
There are several options available to help detect and prevent colorectal cancer in San Antonio TX.
- Colonoscopy. In this exam I pass a small flexible tube with a camera on the tip into and across the entire length of your colon while you are asleep. With this exam polyps can be both found and removed. Bowel prep before exam is required. Click here for more information on the colonoscopy procedure.
- Barium Enema. A small tube is put into your rectum and the radiologist will instill barium (liquid) and air into your colon to dilate it while you are awake. Then x-rays are taken to look for polyps or cancer. Bowel prep before exam is required. If polyps are found you are sent to colonoscopy to have them removed.
- Virtual CT Colonography. A newer study, where you are given contrast to drink and a tube is put in your rectum to instill air into your colon while you are awake. Then you are sent through a CT scanner to take images of your colon. If polyps are found you are sent to colonoscopy to have them removed. Bowel prep before exam is required.
- Fecal Occult Blood Test. This is a test for blood in your stool. Most cancers and most polyps leak small amounts of blood. Your doctor will test your stool for evidence of trace amounts of blood and, if detected, you will be recommended to have a colonoscopy to find the source. Main limit of this test is not all polyps leak blood and if it is a colon cancer that is leaking the blood, many times it is too late.
- Fecal Immunochemical Test (FIT). This is similar to the fecal occult blood test. Your stool is tested for trace amounts of blood. Again the limitation is not all tumors leak blood and most only leak blood intermittently. If blood is detected you will be referred for colonoscopy to find the source.
- Stool DNA Test. This tests your stool for abnormal cell DNA that is typically found in polyps and colon cancer. If found you will be sent for a colonoscopy to find the source. This test is not readily available in the United States.
Colon cancer affects people of all color, sex and ethnic background. Some people with no known risk factors develop colon cancer. Some people with several risk factors never develop colon cancer. But, research has shown that there are certain identifiable risk factors that, if present, make it more important that you get colorectal cancer screening in San Antonio TX.
- Age. Although young people can develop colon cancer 9 out of 10 people that do develop colon cancer are over the age of 50. This is why it is recommended that everyone over age 50 have a colonoscopy.
- Family History. If you have a first degree relative (parent, sibling or child) with colon cancer your risk for colon cancer is higher as well. Having family members with precancerous (adenoma) polyps may increase your risk as well. If colorectal cancer or adenoma polyps are in your family talk to your doctor or contact me, you may need a colonoscopy sooner than age 50.
- Personal History of Polyps or Cancer. If you have had colon polyps on previous colonoscopy or if you have a prior history of a cancer of any type, you are at increased risk for colorectal cancer. The number and type of previous polyps, or type of cancer and age at which it developed, helps us determine your risk and when you should be evaluated.
- Inflammatory Bowel Disease. If you have been diagnosed with Crohn’s or Ulcerative Colitis you are at increased risk for colon cancer. Both of these conditions cause chronic inflammation of your colon that can lead to growth of abnormal cells (dysplastic cells) that are at high risk of progressing to cancer. This is a different growth process than a “typical” colon polyp and has different risks for cancer. Evidence shows that it you have had inflammatory bowel disease for longer than 7 years your risk for colon cancer starts to go up. More diligent screening at that point is the right thing to do because, just like with colon polyps, if dysplasia is found in time it can be removed along with the risk of it becoming cancer.
- Inherited Syndromes. There are certain genetic inherited syndromes that we know increase your risk for colon cancer. Familial Adenomatous Polyposis (FAP) and Hereditary Non-polyposis Colon Cancer (HNPCC) are two examples of this. If you have any genetic syndromes that run in your family speak with your doctor about the risks you have of developing different conditions, like colon cancer, and develop a plan for your screening.
- Racial and Ethnic Background. African Americans and Ashkenazi Jews have the highest incidence of colorectal cancer. The reasons for this are not completely understood.
- Lifestyle Related Factors. We also know that poor diet and lifestyle choices can increase your risk of developing colorectal cancer. Having a diet high in fat, red meat and processed meat, being over weight and not doing much physical activity, smoking and excessive alcohol use all increase your risk of developing colon cancer.
Colon cancer is the second leading cause of cancer death in the United States, behind lung cancer. It is also preventable. Since most all colon cancer develops from colon polyps (small growths of tissue in the colon) that are allowed to continue to grow until they become cancer, the goal for prevention is to find and remove those polyps. The best way to do this is with colonoscopy. Current recommendation is to have your first colonoscopy at age 50 years old (40 year’s old if family history of colon cancer). During your colonoscopy your gastroenterologist will evaluate the inside lining of your colon with a long tube that has a camera on the tip. Any polyps that are found in your colon will be removed at that time. Then, depending on the number and type of polyps you have, you will be put on a surveillance program to catch new ones as they grow.
Colon cancer develops when a colon polyp is allowed to grow too long and change into cancer. The cells that line our colon (large intestine) are constantly being produced, utilized and then shed off and new ones grow back in their place. As this process happens there is a chance one of the cells may develop a defect that allows for uncontrolled cell growth. This uncontrolled growth can develop into a polyp and some of those polyps may continue to grow into a malignant cancer if not removed in time. The malignant cancer will then invade other healthy tissue in and around the colon and can lead to death.
There are two ways to schedule an appointment. One is to contact our office directly at 210-615-8308 and whoever answers the phone will be able to assist you. The second is by clicking this schedule an appointment link and filling in the appropriate information. My office will contact you to make the arrangements. We will also help you deal with and answer all questions regarding your insurance coverage.
Any time you are scheduled to undergo a sedated procedure (upper endoscopy or colonoscopy) it is recommended that you take that day off of work. Once you have been sedated, legally you should not drive or operating machinery for 24 hours. Because of this, it is important that you bring somebody with you to your scheduled exams that can safely get you home afterwards. The day after your exam you can return to full activity.
We used to use the tablet based prep for procedures. However, due to safety concerns by the FDA regarding renal failure in some patients, it was pulled from the shelves for some time. Due to continued safety concerns with this issue that we still have, we have chosen not to offer this to our patients. Your safety is still our primary concern.
There are a few different bowel preps that we use in our practice to help clean out the small bowel and the colon for your exams. The basic premise of all the preps are the same. The goal is to avoid solid foods the day before your exam and drink as much fluids as you can. The cleaner you can get your small bowel (for small bowel capsule endoscopy) or your colon (for colonoscopy) the more thorough and accurate of an exam we can do for you. We understand this is usually the most unplesant part of having a procedure done, but we have all been through it before as well and there are some things you can do to make it easier. Depending upon the time your exam is scheduled for, sometimes your bowel prep can be split so that half of it is taken the night before the exam and half the morning of your exam. This helps decrease the fullness and bloating feeling and gives you a much better washout. It also helps if you refrigerate your bowel prep as it does taste better when it is cold. If you start feeling to full, bloated or nauseated, take a break from the prep for a while until those symptoms resolved and then resume. It also helps to use baby wipes instead of regular toilet paper as once you start going your bottom side will tend to get a little tender. Click on the link below to find specific directions for the prep you are going to use. If there are other questions regarding this please contact my office.
Colonoscopy is a very safe procedure, especially when done by a trained specialist. Like any medical procedure, it carries some potential risks, although they are rare.
- Reaction to sedation medications
Rare, but possible. Our team reviews your medical history to minimize this risk. - Bleeding
Can occur after a biopsy or polyp removal (about 0.1% risk). The risk may be higher if you take certain medications. - Perforation (tear in the colon wall)
Very rare, but it may need additional treatment or surgery if it happens. - Aspiration
Breathing in stomach contents if vomiting occurs—this is why fasting before your procedure is important.
What to watch for after your procedure:
Call our office immediately if you experience severe abdominal pain, fever, chills, or significant bleeding.
Your safety is our top priority, and our team takes every precaution to minimize these risks.