Learn the basics and importance of colonoscopy in Hong Kong with Dr. Ernest Li 李恒輝醫生, a private practice Gastroenterologist and Hepatologist based in Hong Kong.
Colorectal cancer is the most common cancer in Hong Kong. It afflicts a large portion of the population and is most commonly seen in people aged 50 or above. Colon cancer accounted for 16.6% of all new cancer cases in 2015, and this number is said to increase due to both the aging population and the increasing incidence in the younger population.
There are a few preventive and testing methods used to detect not only cancer but other infections or abnormalities present in the colon. The most reliable of these methods is called a colonoscopy. This procedure is a beneficial detection method that some patients tend to avoid due to its invasive nature.
What is a colonoscopy exactly and why is it required?
Colonoscopy is an invasive examination to detect changes or abnormalities in the large intestine, and if necessary, obtain tissue samples or remove abnormal growth. During a colonoscopy, a flexible tube is inserted into the rectum and moved along the entire colon. The tip of the tube contains a light source and a video camera that projects a video image onto a monitor screen for the doctor's examination.
Colonoscopy is intended for investigation of any suspicion of large bowel illness, as well as for prevention of the development of colonic cancer.
What is the colonoscopy patient experience like in Hong Kong?
In private medical practice in Hong Kong, most people undergo colonoscopy under "monitored anesthesia care"(MAC). Therefore the procedure does not hurt. MAC sedation is strong enough to keep the patient sleepy and requires an anesthetist’s support but it is lighter than general anesthesia.
However, some people may also opt for milder sedation without the support of an anesthetist. In that case, some pain (usually tolerable) is expected.
The worst part of a colonoscopy, according to Dr. Li, is the pre-procedural laxative drinks for bowel cleansing. The taste of the laxatives is weird and a large consumption volume (up to 4 liters of fluid) is needed.
Can you walk us through every step of the procedure of colonoscopy?
In the endoscopy suite, nurses will perform an identity check and ask you to sign consent forms. Supplemental oxygen might be given to you through a nasal cannula. Wires will be connected to monitor your vital signs such as heart rate and rhythm, oxygen saturation and blood pressure. An anesthetist will insert a plastic catheter into a small vein, usually in the hand, where sedatives will be injected.
After you fall asleep, the colonoscopy examination will begin with the insertion of an endoscope into the rectum and up to the beginning of the colon. Then the entire colon will be examined starting from the deepest end. Water might be injected through the endoscope to wash away residual fecal material and air will be insufflated to distend the colon wall for better visualization.
Tissue samples will be obtained for abnormalities such as inflammation and ulcers. Colon polyps will be removed. Significant bleedings will be stopped as well. After the colonoscopy is completed, the anesthetist will stop the sedation and you will gradually wake within 10–15 minutes.
To learn more about colon cancer and its symptoms, causes and treatment options, read our complete guide reviewed by a top Hong Kong oncologist.
How do I prepare for a colonoscopy?
First, consult a gastroenterologist to find out whether you need a colonoscopy. Your coexisting medical conditions and current medications will affect the length and complexity of your preparation phase.
For the 3 days before the colonoscopy, you need to undergo a low fiber diet — no vegetables or fresh fruits (good news for meat lovers). This is because fiber tends to obscure the view during colonoscopy.
On the day before the colonoscopy, you need to be on a fluid diet. On the night before colonoscopy, you need to start drinking laxatives according to your gastroenterologist’s regimen. You can expect to go to the toilet around 10 times that night. On the day of your colonoscopy, you need to keep fast for at least 6 hours.
What are the medical risks?
Some laxatives may cause electrolyte imbalance and dehydration. Your gastroenterologist should choose appropriate laxatives according to your age and health status. Sedation risks include low blood pressure and compromised breathing effort — but these conditions can be safely managed by the anesthetist. Aspiration pneumonia is rare if you have adequately fasted. A colonoscopy may cause perforation of the colon (1 in 600) which requires surgical repair. While tissue samplings and polyp resections (i.e. removals) are associated with risks of significant bleeding, most bleedings can be managed endoscopically.
How often should I undergo a colonoscopy?
You should consider a colonoscopy if you have newly developed or uninvestigated bowel symptoms such as abdominal pain, altered bowel habits, passing blood or mucus per your rectum. If you have any family members with colon cancer or polyps; or you are over 40 years of age, you should also consider screening colonoscopy to remove colon polyps.
Intervals between subsequent colonoscopies will depend on the number, size and pathology of the polyps found in your latest colonoscopy. In most circumstances, the intervals range from 1–5 years.
Where can I get a colonoscopy in Hong Kong?
Public sector: most government hospitals provide colonoscopy for suspected bowel disease but not for screening purposes. You need to see a general practitioner or family physician first and get a referral letter to see a specialist. The waiting time for the first consultation with a specialist can be up to 1–2 years, and the waiting time for a colonoscopy appointment is around 1 year after seeing the specialist.
Private sector: most gastroenterologists in Hong Kong are well-trained in performing colonoscopies. Colorectal surgeons are also trained in colonoscopy but it is difficult to know which surgeons specialize in the colorectal area. Gastroenterologists can perform colonoscopies in private hospitals or endoscopy centers in commercial buildings. Waiting times are very short.
What is the difference between an inpatient and outpatient colonoscopy in Hong Kong?
Colonoscopy in Hong Kong can be performed in hospitals or endoscopy centers in commercial buildings. Endoscopy centers can only cater to outpatient colonoscopy. If any complications arise, then you will be transferred by ambulance to an Accident & Emergency Department of a nearby Hospital Authority hospital (public hospital).
Colonoscopy in Hong Kong private hospitals can be either inpatient or outpatient. Inpatient means you will be admitted to the hospital the night before your colonoscopy, and your bowel preparation will be done in the hospital; outpatient means your bowel preparation will be done at home and you will need to travel to the hospital the morning of your appointment. In both cases, you can be discharged around 2 hours after the colonoscopy procedure. It is safer to arrange someone to accompany you back home.
What is the current average cost in Hong Kong?
A colonoscopy in Hong Kong costs around HK$20,000 in the private sector. Some doctors are more expensive, so the cost can be a few times more.
How do I prevent colon cancer?
Male gender and aging are associated with higher chances of getting colon cancer. Lifestyle preventive measures include no smoking, no excessive alcohol intake, regular exercise, avoiding central obesity and a high fiber diet. Most importantly, it is recommended to undergo regular colonoscopy screening when you are over 40 years old.
If you have recently experienced bowel symptoms like abdominal pain, altered bowel habits, passing blood or mucus in your feces, you should consider a colonoscopy. Also, if you are aged over 40 or have a family health history of colon cancer or polyps, colonoscopy is recommended on a regular basis.
Dr. Ernest Li 李恒輝醫生 is Chinese Canadian and a Gastroenterologist and Hepatologist. After graduating in Physics at McGill University, he studied medicine at the Chinese University of Hong Kong. He then received 12 years of training at government hospitals, and achieved specialist qualifications in gastroenterology, hepatology and internal medicine. Currently, he is a private practitioner with an office in Central, and also a part-time associate consultant for Hospital Authority.
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This article was independently written by Healthy Matters and is not sponsored. It is informative only and not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be relied upon for specific medical advice.