ffl0203t8 wrote:...The other question I have is what happens if there is a perforation of my colon during the procedure? Can they try to fix it during the colonoscopy, or would I need to be sent directly to a hospital?
You have already received some very good experience-related comments from Utwo. I also have some thoughts, but mine are second-hand reflections derived mainly from various articles and web-sites I have seen in the past few days. I have no direct experience with colonoscopic or endoscopic therapeutic procedures. You would have to check with you doctor to see if any of the comments below apply to you.
One of the things that I found in my reading is that there are three main ways that an endoscopist can deal with small perforations that occur during the procedure. These are: 1. To use a heated colonoscope attachment to cauterize and close the wound; 2. To use a different colonoscope attachment to squirt a special kind of biological "super glue" on the perforation; and, 3. To close the wound with a clamp or series of clips.
I also found that there are different kinds of perforations that can happen. They can be grouped into two groups: 1. Blunt-object injuries and 2. Sharp-object injuries.
In the first category are the colonoscopy surveillance cases where the colonoscope, with its light and camera out in front, gets stuck in a diverticula pocket or in a sharp hair-pin curve like the recto-sigmoid junction and the doctor exerts too much pressure and causes a big perforation in the weak colon wall. This doesn't happen very often and is said to have a perforation risk around 1/1000.
In the second category are the therapeutic colonoscopic procedures where sharp colonoscope attachments are used to perform polyp removal operations or to grab biopsy samples for analysis. For this type of procedure, the risk of perforation is said to be around 1/500. In cases where the mass to be removed is a very large flat polyp that spans several folds in the colon wall and that requires the polyp to be removed in several successive sections, the risk is even higher.
In the case of Endoscopic Submucosal Dissection (ESD) the situation is a bit different. This procedure apparently requires the use of two different sharp attachments: 1. A needle attachment is first used to inject a colored saline solution underneath the mass in order to elevate the whole mass above the cecum wall so that it will be easier to excise it; 2. A heated scalpel attachment is then used to cut around the circumference of the mass and to then lift it off the cecum wall in one piece; and 3. A needle attachment is then used to tattoo the cecum wall at the location of the original mass. Any of these operations can cause an unintended puncture of the cecum wall if the doctor is not extremely careful.
And there is another distinction I ran across in my reading. This is the distinction between: 1. Recognized Perforations, and 2. Unrecognized Perforations.
In the first case, the doctor realizes that a perforation has in fact occurred and he then takes whatever measures he has available to deal with it, including some of the ones mentioned above. The second case is considered by some to be the more serious, however. In this case, the doctor has unwittingly made a small pinhole perforation in the cecum wall but doesn't realize it. He then finishes the procedure, tells the patient that everything is OK, but he doesn't arrange for any special preventive measures. Then, in a week or two the patient finds himself in the hospital with sepsis or septicemia, which could have been prevented if the doctor had implemented an aggressive antibiotic cocktail regimen and told the patient to be extremely careful to eat only small snacks of mostly bland, non-spicy, low-residue foods, and no carbonated beverages or other foods that produce gas. This is so that the cecum can rest in peace for a couple of weeks while any presumed pinhole injuries are given time to heal naturally.