Colonoscopy is a long flexible tube also known as a fiberoptic endoscopy used to examine the colon. It is inserted into the anus, rectum and the colon when one is sedated or asleep .It can accurately examine the entire large intestine or colon, and has the advantage that if anything abnormal( polyps or growths) is found, a biopsy be taken straightaway. If a polyp of reasonable size is found, it can also be removed entirely at the same time. The colon should never have polyps , and any polyps found in the colon should be removed for histological examination ( i.e. examine the cell type under a microscope).We know that colon cancer starts from polyps, and if we can screen the colon and remove polyps when they arise, we can effectively prevent colorectal cancer. There are several ways to examine a colon ( i.e. CT colonography, barium enema, colonoscopy etc) but examination by colonoscopy is the most accurate and the "gold -standard" test .It is both diagnostic and therapeutic, as it can not only detect cancer, but it can also prevent cancer via polypectomy( or otherwise known as polyp removal).In addition, the other alternatives tests ( barium enema etc)also have risk of perforation, and also uncomfortable as the patient is not sedated. Furthermore,If barium enema or CT colonography detect any colon problem, you will still be referred for a colonoscopy for biopsy. Hence, colonoscopy is usually investigation of first choice.

Now in Singapore, the cancer is the number 1 killer. Colorectal cancer is the number 1 cancer amongst men ,and number 2 amongst women. For Men and Women combined together, Colorectal cancer is the number 1 Cancer. Yet it is easily preventable through colonoscopic screening and polyp removal. Whilst diet and healthy lifestyle has a role to play, but the most significant prevention is still via colonoscopy examination. Even people who are vegetarians and don't eat meat also get colorectal cancer ,hence emphasizing that diet alone is not enough for colorectal cancer prevention. Screening now is readily available, convenient and safe in expert specialist hands. There is minimally or no discomfort as one is usually sedated or put to sleep. It takes approximately 15 - 20 mins for a complete examination on average. It is done as a day procedure without need for admission , and is affordable , being medisave reimbursable and insurance claimable. The usual preparation for a scope only entails some diet restriction the day before, then a "bowel prep" where one drinks a laxative to clear the colon of stools, and this is usually the most uncomfortable part, not the actual scope itself!

So when should we do a colonoscopy? If you are absolutely feeling very well, and you have no family history of colorectal cancer, screening should start at age 50 years old. If you have persistent or worrying symptoms such as bleeding, change in bowel habits or something vague like abdominal pain and bloatedness, we would consider investigating at any age . We know of cases of colorectal cancer occurring in patients in their 20s, 30and 40s, hence without screening,we never know what is going on inside your colon, and we will screen at any age ,if clinically indicated. Even if have something as common as blood in your stools, don't simple assume it's just piles or haemorhoids. Especially if there are worrying symptoms, or persistent symptoms despite treatment, we should always check if other than piles, is there something more serious further inside your colon. We should also remember that early cancer or polyps usually have no symptoms. When symptoms (i.e. bleeding, pain, abdominal distension etc ) start to occur, sometime it may be too late as the tumour would have grown to a certain advanced stage to start giving symptoms. Early Colorectal cancer if detected during endoscopy, has a very high chance of cure after surgery is done to remove it.

Colonoscopy is highly advantages and its benefits are numerous. It is cost effective if we can prevent cancer though polyp removal, and potentially lifesaving. It is a safe procedure and the small risks involved include infection, bleeding and perforation ,which is 1:1000 or 0.01%.. Having done one at the appropriate age, and the colon is free of polyps and cancer, we usually don't need to repeat one forth next 5-10 years. However, if polyps are removed, depending on the type of polyp( whether it is precancerous) we will the put the patient on a polyp surveillance programme and repeat the endoscopy in 1-3 years, as we know polyps can grow back in the same place or somewhere else within the colon. If the next scope doesn't reveal any more new polyps, then we can go back to 5-10 yearly interval for colonoscopy. However, if you have a family history of colorectal cancer, then we will advise you at what age and interval to do colon screening.

The need for a colonoscopy will be discussed with you after a consultation and physical examination, to determine if you require a more thorough colon check. It is safe and convenient ,and can be done at a time of your choice. It will usually be comfortable and you will be sedated for the procedure. Colonoscopy can be done for the investigation of common symptoms such as constipation, blood in your stools, abdominal pain, abdominal belatedness, change in bowel habits, anemia ( to check for internal bleeding) and numerous other symptoms. It is cost effective and potential lifesaving. As none of us can see inside of another's colon, it is best to check and know for sure if there is a problem within. If there is, we intervene appropriate, if all is well, we have peace of mind thereafter.