Advanced Colonoscopy

What is advanced colonoscopy?

Undergoing advanced colonoscopy is similar to undergoing a typical diagnostic or screening colonoscopy. During advanced colonoscopy, the surgeon may use additional specialised tools e.g. fold flattening devices, and specialised techniques e.g. water immersion, endoscopic mucosal resection for removal of challenging or medium to large sized polyps and endoscopic stent placements 

What is endoscopic mucosal resection (EMR) and when is this indicated? 

This process involves large polyp (greater than 2cm) excision after injecting a fluid to the second layer of the colon, to create a barrier between the innermost layer and the third layer (muscular layer) of the colon or rectum. Larger lesions may be removed in a piecemeal (multiple small pieces till complete clearance is reached) fashion. 

When is endoscopic stent indicated? 

Indication for colonic stents: Palliation in the setting of colorectal cancer 

• Patients with colorectal cancer and incurable metastatic (distant) disease 

• Patients with colorectal cancer without metastatic disease but with severe comorbidities (thus not a surgical candidate for major bowel surgery) 

What are the risks for endoscopic stent placement?

• Mortality 1-2% 

• Perforation ~5% 

• Migration of stent 5-10% (often seen in patients post chemoradiotherapy), or in patients who have achieved inadequate stent expansion 

• Obstruction after successful decompression: usually due to advancement of tumour 

• Bleeding < 5% usually mild and treatment often not required 

• Pain / discomfort is the most common complain by patients. The key is to exclude a complication and manage with analgesia 

Who should be doing your advanced colonoscopy?

These advanced techniques / manoeuvres should be performed by a either a colorectal surgeon (CSSANZ member) or a gastroenterologist who specialises in endoscopic treatment of the gastrointestinal tract.