Colonoscopy - Medical specialists

Colonoscopy provides a method of examining the interior parts of the large intestine (colon) and rectum. For this purpose, a colonoscope is used. This tool consists of a thin, flexible tube (that can be as much as four feet long) that has a tiny camera attached.

Overview

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Colonoscopy - Further information

A colonoscopy procedure can provide real-time visual data, which is valuable for many medical investigations. Thus, a colonoscopy may be carried out for different purposes by a primary care physician, a surgeon or a specialist from a discipline such as gastroenterology.

Which illnesses do colonoscopy specialists treat?

A colonoscopy may be performed in connection with routine, age-related screening programmes to check for bowel cancers and similar conditions. However, the procedure may also be requested as part of the diagnosis, investigations or treatments required for a number of different symptoms, conditions and illnesses. These may include: 

  • a gastrointestinal haemorrhage
  • gastric ulcers
  • abdominal pain, unexplained changes in bowel habits, or weight loss
  • abnormal changes (such as the presence of polyps) found on a sigmoidoscopy (a partial colon examination), X-ray tests or a CT (computer tomography) scan
  • anemia due to low iron (normally if no other cause has been identified elsewhere)
  • the presence of blood in the stools, or black, tarry stools
  • a follow-up procedure based on a past discovery, such as the presence of polyps (small growths) or signs of colon cancer
  • inflammatory bowel disease (e.g. ulcerative colitis or Crohn’s disease)
  • other inflammatory conditions, such as diverticulosis

What treatment methods are used by colonoscopy specialists?

During the colonoscopy procedure, the physician may remove any polyps found and pass them to the pathology lab for testing. Most colon polyps are harmless and commonly occur in adults. Nevertheless, most colon cancers also start off in the form of polyps, so their early removal is an effective method of cancer prevention. The specialist may also perform a biopsy to obtain a tissue sample, which will then be analysed by a pathologist.

Diagram showing a colonoscopy CRUK 060

Although traditional colonoscopy remains the primary screening and treatment tool for colon investigations, an alternative virtual colonoscopy procedure is also used on some occasions.

Virtual colonoscopy uses CT (computer tomography) scanning to create images of the colon. These are ‘virtual’ images because they are obtained via a scan and not through direct observation. When skillfully performed, a virtual colonoscopy can find polyps hidden behind intestinal folds, which are occasionally missed by a colonoscopy.

Nevertheless, virtual colonoscopy has its limitations:

  • virtual colonoscopy has trouble identifying polyps less than 5 mm in size, which are easily spotted during a colonoscopy
  • virtual colonoscopy also struggles to identify non-protruding cancers or pre-malignant lesions that do not appear polyp-like
  • virtual colonoscopy cannot remove any polyps discovered, which means that a further colonoscopy is then required

What additional qualifications are required by colonoscopy specialists?

Gastroenterologists tend to undertake more colonoscopy procedures than other medical professionals, and their education and training, as well as their work focus on the gastrointestinal tract, gives them plenty of opportunity to develop their knowledge and expertise.

A gastroenterologist must first complete four years of medical school, after which they must undergo a three-year residency (training program) in internal medicine. This practice-based training involves working in a team along with more experienced gastroenterologists.

After finishing the residency, the trainee gastroenterologist may then complete a two or three-year fellowship to develop additional specialisms in this discipline. It is under the fellowship option that gastroenterologists are taught the specific skills of performing colonoscopies and similar minimally invasive techniques. Training includes the use of colonoscopy for both diagnostic and surgical purposes.

In order to remain board-certified, qualified gastroenterologists must continually update their skills and knowledge to include the latest developments in their field.

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