can i smoke cigarettes after a colonoscopy

50 y/o male. Primary outcomes of incisional infections, infectious and major complications, and mortality were evaluated using regression modeling adjusting for patient characteristics and comorbidities. nitrosamines. 2023 Feb;20(2):391-402. doi: 10.1111/iwj.13887. The endoscope is a medical instrument by which it is possible to observe in detail some part of the body, while at the same time, through the tube or probe, small instruments can be inserted that help the specialist to take a tissue sample, extract some material that It should not be in that place, eliminate tumors, stop some bleeding, treat diseases, among others. Once safely home, the care guidelines would generally be as follows: 1. Those who smoked during the 24 hours before outpatient surgery with general anesthetics are more likely to have periods of inadequate oxygen supply to the heart than non-smokers, ex-smokers, or even smokers who quit 24 hours beforehand. Likewise, there areseveral types of endoscopyaccording to the area to be examined and each of them is used to detect or treat numerous alterations. The cookie is set by GDPR cookie consent to record the user consent for the cookies in the category "Functional". Look for other causes. Failure to comply may result . Do you need underlay for laminate flooring on concrete? Mom is smoker ( around 2 fags a day). Some research suggests that smoking increases the risk of developing gallstones. The most commons are: Depending on the type of endoscopy, the instructions that the doctor makes before undergoing the procedure will vary. Reminders Ensure you have a driver to take you home after the procedure. This consists of a limited amount of dairy, plus low-fiber foods which are easy to digest and produce less stool. drinker, obese, bad diet. never smoked. Chewing gum can increase stomach contents which increases the risk of anesthesia complications. Healthline Media does not provide medical advice, diagnosis, or treatment. Doctors typically provide answers within 24 hours. No matter if youre a new smoker or youve smoked for 20 years, its still crucial to quit smoking on matter what. What happens if you smoke before endoscopy? Fasting for 4 to 12 hours before the procedure. It does not store any personal data. "Anesthesiologists have to work harder . This cookie is set by GDPR Cookie Consent plugin. eCollection 2022. Any liquid that you can see through (clear liquids) is allowed--tea, black coffee, water, ju Dr. Francine Yep and another doctor agree. Smoking compromises heart function, putting a patient at a greater risk for heart problems during or after surgery. Stop smoking 6+ hours before hand and stop edibles 24+ hours before hand. Wish you good health! The answer is no, and here's why. Smoking is always bad for you. One researcher concluded in 2002 that . We do not endorse non-Cleveland Clinic products or services. What happens if you smoke before endoscopy? They may suggest a soft or liquid diet thats low in residue. 2015 Feb;102(3):269-80. doi: 10.1002/bjs.9696. A 64-year-old female asked: I've had 3 colonoscopies over the last 15 years. This, like other post-procedure care, will depend on the type of endoscopy and the reason it was performed. Some doctors may advise you to avoid smoking before a colonoscopy, as some studies have suggested it may increase the risk of bleeding or infection. 6 Is it okay to smoke before a colonoscopy? Methods: This is partly due to the procedure itself, and partly due to the bowel prep you went through before it. your prescribing physician for instructions. If you have not registered with the new gPortal yet please select the Register/Learn More button for instructions on registering. The toxins in the blood of smokers also permeate the tissue, which further compromises thehealing process. Primary Menu. Church JM. The fact that you are a regular smoker could cause complications with the anesthesia; anything from you waking up during the procedure to you dying during the procedure. Our experts continually monitor the health and wellness space, and we update our articles when new information becomes available. non-smoker, non-drinker, normal weight. There are many reasons you should avoid smoking following a root canal: First, the effects of smoking may increase your likelihood of getting a root . Failure to comply may result in the cancellation of your procedure. So you can wait but should have a repeat test in 2025/26. If you smoke, your doctor may advise you to stop before the colonoscopy. Smoking marijuana before surgery can result in some serious health complications, particularly as a result of the drug's interaction with anesthesia. . If you smoke, you should discuss the following with your doctor: There are several different types of colonoscopy. Surgical Planning in Penetrating Abdominal Crohn's Disease. Clipboard, Search History, and several other advanced features are temporarily unavailable. Objective: Since marijuana and anesthesia both affect the central nervous system, people who use marijuana regularly may need different amounts of anesthesia . Federal government websites often end in .gov or .mil. This will allow your doctor to view any abnormalities, like polyps or cancer, that may be present. Is it okay to smoke before a colonoscopy? By clicking Accept All, you consent to the use of ALL the cookies. Video chat with a U.S. board-certified doctor 24/7 in less than one minute for common issues such as: colds and coughs, stomach symptoms, bladder infections, rashes, and more. Servicios de colonoscopia de fcil preparacin, 7 Reasons You Should Get A Colonoscopy (Even If You Dont Want To), Colon Cancer Rates Are Rising in Younger People, 7 Simple Tricks for Fast Relief from Heartburn, Six Signs Your Heartburn Could Be Something More Serious, Barretts Esophagus Screening in San Antonio, San Antonio Website Design & Development - Backyard Studios. 8600 Rockville Pike This time may vary depending on the type of endoscopy. We strongly encourage you to not smoke within 24 hours of your procedure. Impact of preoperative smoking on patients undergoing right hemicolectomies for colon cancer. Studies to date have implicated smoking as a risk factor for increased postoperative complications. This can help diagnose colorectal cancer or a variety of other. precancerous conditions. Your doctor will also give you instructions about what to do if you have any of the following: You should also be prepared to take your usual medications. Talent Agents Now Hiring New Faces Paid Kids Acting & Modeling jobs Reporting of tobacco use and tobacco-related analyses in cancer cooperative group clinical trials: a systematic scoping review. You will be given a sedative that will help you relax and fall asleep during the procedure. Please enable it to take advantage of the complete set of features! When can i eat after my colonoscopy procedure? All Rights Reserved. If you want to read more articles similar toCan I smoke after an endoscopy? Links with this icon indicate that you are leaving the CDC website.. abnormal growths. If the bowel prep is not done properly, it could delay your procedure or affect your doctors ability to perform the examination. tabor college basketball waterstones vacancies scotland. Smoking before surgery can diminish the blood flow to the heart. Bethesda, MD 20894, Web Policies Can you smoke cigarettes after colonoscopy? Around 3 days after quitting, most people will experience moodiness and irritability, severe headaches, and cravings as the body readjusts. http://www.mayoclinic.org/diseases-conditions/colon-polyps/basics/definition/ Too much radiation. All people, non-smokers and smokers, should have colonoscopy initially at age 50 and then every 5 years. Results are visual, not chemical. Is smoking marijuana safe before a colonoscopy? The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. These sensations will pass as the colonoscope is passed through your colon. "Hey baby, I hear the blues a-callin'. what am i to expect tonight and during the procedure? You may feel a slight pressure and tug on the colonoscope when it is passed through your anus to the beginning of your colon. It has been a long time since your last bowel movement. The site is secure. I have my endoscopy and colonoscopy in a week can I continue to smoke before them or will I have to take a break and go insane with my moods? However, if these are not performed as indicated, the result may be altered, so the examination may have to be done again on another date. 52 yrs. 2022 Dec;7(6):100605. doi: 10.1016/j.esmoop.2022.100605. Secondhand smoke can cause coronary heart disease, stroke and lung cancer.. But what happens when youre a smoker but have an upcoming surgery and your doctor tells you to quit right away? But opting out of some of these cookies may affect your browsing experience. This includes family history, personal history, or the presence of polyps. Smoking can cause complications during or after the procedure. Tell them that you smoke pot; be completely honest with them. had colonoscopy. I've had 3 colonoscopies over the last 15 years. So you can wait but s. ._2JU2WQDzn5pAlpxqChbxr7{height:16px;margin-right:8px;width:16px}._3E45je-29yDjfFqFcLCXyH{margin-top:16px}._13YtS_rCnVZG1ns2xaCalg{font-family:Noto Sans,Arial,sans-serif;font-size:14px;font-weight:400;line-height:18px;display:-ms-flexbox;display:flex}._1m5fPZN4q3vKVg9SgU43u2{margin-top:12px}._17A-IdW3j1_fI_pN-8tMV-{display:inline-block;margin-bottom:8px;margin-right:5px}._5MIPBF8A9vXwwXFumpGqY{border-radius:20px;font-size:12px;font-weight:500;letter-spacing:0;line-height:16px;padding:3px 10px;text-transform:none}._5MIPBF8A9vXwwXFumpGqY:focus{outline:unset} The cookie is used to store the user consent for the cookies in the category "Analytics". Not sure if this is the right place but I smoke pretty much everyday to control my moods from having borderline personality disorder. Smoking cigarettes makes it harder for blood to travel through your body. Do yourself a favor an qui A variety of different types all with different implications. Epub 2014 Dec 18. It could take 2 to 3 days before you have a bowel movement after your colonoscopy because you completely emptied your colon and rectum ahead of the procedure. Smoking can cause complications during or after the procedure. By using our website, you consent to our use of cookies. It will not affect the results of anything they find at this point either. Depends on what was its purpose. Smokers are 38 percent more likely to die after surgery than non-smokers. The process can harm your immune system and form a probably unclean environment. It is normal to feel bloated and to have some abdominal discomfort. Your doctor may also recommend you follow a soft, low-residue diet immediately after the procedure. Whether you should stop smoking before a colonoscopy. Policy. last screening 2016. how many years before next one? You will also need to stop smoking for several days before your procedure. While there is no definitive proof that smoking before a colonoscopy increases the risk of complications, there are several reasons why it is not advised. my mom died from colon cancer in 1997. smoked 20yr, avg. These cookies help provide information on metrics the number of visitors, bounce rate, traffic source, etc. Whether its your first colonoscopy or your 5th, here are 5 mistakes you dont want to make when it comes to colonoscopy screenings: The biggest mistake you can make with a colonoscopy is not getting one when youre supposed to. all negative. However, a very common requirement is that smokers abstain from this habit before undergoing the procedure, but they have the question,can I smoke after an endoscopy? We use cookies on our website to give you the most relevant experience by remembering your preferences and repeat visits. The anesthesia team can tell immediately if the patient is a smoker. It is never ok to smoke. The appropriate thing is that after undergoing an endoscopy the patientdoes not smoke during the first 24 hours , however, if you are a smoker you should consult the specialist directly about this question, since recovery times may depend on several factors such as mentioned above or in these cases it could indicate smoking in a small amount after a certain time. You can learn more about how we ensure our content is accurate and current by reading our. Background: Studies to date have implicated smoking as a risk factor for increased postoperative complications. If you had a polyp removed, your doctor may recommend additional dietary guidelines. Do not smoke cigarettes or Cigars 24-48 hours before procedure, please notify staff if you did smoke (very important). People with risk factors may . Epub 2022 Mar 15. Home; Uncategorized; can i smoke cigarettes after a colonoscopy; employee experience software market size; When you arrive at your procedure, you will probably (hopefully) have a consultation with the anesthesiologist before your procedure. Exercise . Colonoscopy: Ask the expert Everything you want to know but are afraid to ask. These cookies will be stored in your browser only with your consent. Anesthesia is used during a colonoscopy, and having an empty stomach reduces the risk of certain risk factors. However, since you have a polyp, talk to your GI about repea No- simply continue with routine physicial exams and chest xryas. Br J Surg. How can i feel after a colonoscopy procedure? i feel no affects of the medication? The cookie is used to store the user consent for the cookies in the category "Other. You may also need to take stool softeners or laxatives before your procedure to help your bowels move and empty. Cheema FN, Abraham NS, Berger DH, Albo D, Taffet GE, Naik AD. Smoking is a known risk factor for colon cancer. All rights reserved. official website and that any information you provide is encrypted Enzymes in your body break down the nicotine into metabolites like cotinine and anabasine, which . Polyps or tissue growths may have been removed during your colonoscopy. Performance cookies are used to understand and analyze the key performance indexes of the website which helps in delivering a better user experience for the visitors. These cookies ensure basic functionalities and security features of the website, anonymously. How long does it take to recover after quitting smoking? GCSA does not allow taxis, Uber/Lyft, or public transportation following anesthesia. light drinker. Whats the Difference Between Magnetic Resonance and Endoscopic Retrograde Cholangiopancreatography? Anesthesiologists have to work harder to keep smokers breathing while under anesthesia, fighting against lungs compromised by cigarette smoke, says Dr. Choi. More than 60% of patients had never smoked, 20.4% were current smokers, and 19.2% were ex-smokers. sharing sensitive information, make sure youre on a federal john chidsey email address . Video chat with a U.S. board-certified doctor 24/7 in less than one minute for common issues such as: colds and coughs, stomach symptoms, bladder infections, rashes, and more. In comparing smokers with former smokers, researchers found smokers were 17% more likely to die and 53% more likely to have serious heart and lung problems. Your doctor will also need to know if you drink any alcohol during the week before your procedure. We strongly encourage you to not smoke within 24 hours of your procedure. The doctor didn't say anything about marijuana use, but was told to stop drinking 24 hours before and not to eat or smoke cigarettes the midnight before. Langenbecks Arch Surg. Do not chew gum or tobacco at least three hours prior to your arrival time. Everyone aged 45 and above should have a colonoscopy. Synchronous colorectal carcinoma: a risk factor in colorectal cancer surgery. Do not drive a car or operate heavy machinery for the next 24 hours. Get prescriptions or refills through a video chat, if the doctor feels the prescriptions are medically appropriate. Do Not drink any alcohol or smoke/vape any type of tobacco products within 24 hours. The American College of Surgeon's National Surgical Quality Improvement Program (2005-2010) database was queried for patients undergoing elective major colorectal resection for colorectal cancer, diverticular disease, or inflammatory bowel disease. ulcers. Can You Use Your Diet to Cleanse Your Colon? I had colonoscopy and after the procedure i had no pain and almost 24 hours of it i start having pain is this normal? A colonoscopy is a safe, simple procedure that allows your doctor to check for any abnormalities in your colon. In some cases, your doctor may advise you to stop smoking completely. Dr. Choi explains why smoking before surgery is risky: The anesthesia team can tell immediately if the patient is a smoker. What Happens to Your Body When You Quit Smoking? Another reason why you cannot smoke after the endoscopy is that if the tube was inserted through the mouth, thethroatis likely tobe swollen and you will feel pain, the symptoms of which may disappear in 1 or 2 days. Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. What episode does Aria break up with Ezra? It's the age. bowel . effects of imperialism in japan; my boyfriend takes care of his family; can ryobi brad nailer use staples; white lily cookie run: kingdom; jerusalem cross with three crowns; how to knit checkerboard pattern with two colors; two faces of . New comments cannot be posted and votes cannot be cast, The go-to subreddit for anything and everything cannabis. After smoking a cigarette, nicotine and its by-products stay in a person's urine and saliva for 4 days and blood for up to 10 days. Screening is testing for diseases when you have no symptoms. This includes anything that might irritate your bowels, such as spicy foods and those high in fiber. NO GUM or HARD CANDY or CHEWING TOBACCO. Do yourself a favor an quit. Anesthesia Concerns If you smoke or vape nicotine, it can also affect your lungs and heart, which are stressed during any surgical procedure. "The only thing that I noticed was an increased dryness in my mouth due to the anesthesia and vaping. Smokers are 80 percent more likely to have a heart attack and 70 percent more likely to have a stroke. Don't overuse nicotine in the vaping liquids. The poly is likely to be benign. however, i can see food bits in the toilet and it's a cloudy brown. If you currently smoke cigarettes, vaping can reduce your exposure to these chemicals and potentially decrease your . If it was for screening and nothing was found, usually that's it. Most surgery protocols require the patient to abstain from eating for a certain number of hours before the operation to prevent complications with anesthesia and digestion. Your doctor may recommend a colonoscopy if you have: In some cases, your doctor may recommend a colonoscopy during an unrelated procedure. Learn what the procedure involves and how to prepare for it. This depends on how you feel and if you have any na with that first meal. Your doctor might want to do a follow-up colonoscopy in a few weeks to check for any abnormalities. 6 Sore Throat Remedies That Actually Work. Can I take my fioricet before my colonoscopy, Can i smoke marijuana after a colonoscopy, Can i smoke weed before my ganglion cyst exsision, Can I smoke marijuana before an angiogram. In the hours immediately following a colonoscopy, a doctor may recommend that you eat sparingly, or not at all. Can I smoke cigarettes the day of my colonoscopy? The colonoscope will then be passed through your colon and out the other end. Just clear tips and lifehacks for every day. Everyone aged 45 and above should have a colonoscopy. Results: Reduce your risk of lung cancer and heart disease. In general,preparation for endoscopymay include: In some types of endoscopy,the patient isstrictly requirednot to smoke for at least 12 hours priorto performing the procedure, especially in bronchoscopy and upper gastrointestinal endoscopy. i have a pretty bad head ache from the lack of both and slight insomnia? It is a very simple procedure that does not usually take more than 30 minutes, depending on the area to be explored. I smoked last night. no polyps. We avoid using tertiary references. Accredited by the Association for Ambulatory Health Care, Inc. All Rights Reserved. Linking to a non-federal website does not constitute an endorsement by CDC or any of its employees of the sponsors or the information and products presented on the website. any ideas? 1 Is it OK to smoke before a colonoscopy? Model for risk adjustment of postoperative mortality in patients with colorectal cancer. Its used to detect potential health problems in the colon, such as polyps and colorectal cancer. Would love your thoughts, please comment. . Objective: The aim of this study was to delineate the impact of smoking on postoperative outcomes after colorectal resection for malignant and benign processes. Analytical cookies are used to understand how visitors interact with the website. The American Society of Anesthesiologistsreportsthat smoking reduces blood flow and your surgical incisions are more likely to become infected since it slows healing. I had a endoscopy and colonoscopy today 12 hours ago. take it with small sips of water only, AT LEAST 4 hours before your procedure. Colonoscopy Preparation: What You Should Do in Advance, How to Eat (and Recover from) a Low Fiber Diet, Everything You Need to Know Before a Fecal Occult Blood Test. If your system cant tolerate your usual diet immediately, continue to eat soft and liquid-based foods for an extra day or two. Stop taking certain medications the day of the procedure or the day before, such as acetylsalicylic acid, ibuprofen, naproxen, blood thinners, antidepressants, drugs for high blood pressure and diabetes. You must be completely sober for the procedure. Unauthorized use of these marks is strictly prohibited. Can i remain awake for a colonoscopy? You will most likely be asked to stop drinking and eating for the entire day prior to your procedure. A few days before the colonoscopy procedure Start eating a low-fiber diet: no whole grains, nuts, seeds, dried fruit, or raw fruits or vegetables. Most people only need this screening done once per decade. Rest the remainder of the day, and resume normal activity the next day. my mom died from colon cancer in 1997. smoked 20yr, avg. Smoking can cause complications during or after the procedure. In some it is strict that the person is fasting or follow a special diet, while others do not need a particular measure. Epub 2012 May 27. Likewise, after the procedure, the patient is usually transferred to a recovery area to monitor blood pressure and pulse, the wait can be one hour in which sedation decreases and as it is anoutpatient procedureit is not necessary to spend the night in the medical center, but as long as the patient remains in it the patient will not be able to smoke. replace sling stud with rail. By using our website, you consent to our use of cookies. you are given and increase the effects of both. Surgery is a great time to quit, says Dr. Choi. The pancreas makes and releases an enzyme called lipase into the digestive tract when you eat. The preparation for the dental crown is intensive and requires some time for healing. . Is smoking okay? 2015 May;58(5):494-501. doi: 10.1097/DCR.0000000000000358. For the rest of that day and the day after, youll be advised to drink lots of fluid and to eat soft, easily digestible foods which wont irritate your colon. In fact, if it helps relax you before t. OneJAMAstudycomparedpost-surgery risks for 125,000 smokers, 78,000 former smokers (who quit at least a year before surgery) and 400,000 nonsmokers. Colorectal cancer screening tests. non-smoker, non-drinker, normal weight. When satisfied, please click ACCEPT to give answer credit. Educational text answers on HealthTap are not intended for individual diagnosis, treatment or prescription. As the lungs heal and lung capacity improves, former smokers may notice less . I hadn't really thought of the side effects of smoking marijuana prior, but now I am worried. After 10 years: The risk of lung cancer and bladder cancer is half that of someone who currently smokes. We strongly encourage you to not smoke within 24 hours of your procedure. A 2015 study reported obesity especially abdominal obesity and type 2 diabetes are risk factors for colon cancer. what can i eat 2 days before my colonoscopy; police chase in ontario california; fowles auction catalogue. . This is because, unlike surgery that is usually performed with cuts of considerable size to reach the area to be treated and that recovery can be slow, for endoscopy the probe is inserted through natural openings such as the mouth, the urethra and anus or a small incision is made, which heals quickly. Healthy habits have a large effect on your colon health. Staying active especially by exercising is also important for your colon health. Failure to comply may result in the cancellation of your procedure. American Cancer Society guidelines recommend yearly lung cancer screening for people who meet certain criteria that put them at higher risk for developing the disease. Check labs especially hemoglobin which is a marker of anemia. What can possibly go wrong during a colonoscopy procedure ? You are at higher risk for colon cancer if you: smoke cigarettes, or you are regularly exposed to second-hand smoking; are obese or overweight; are male; Can you smoke the day of a colonoscopy? Frequent or persistent diarrhea or constipation. Having any amount of nicotine in your system will affect anesthesia in a number of ways. It is never ok to smoke. Colonoscopies can detect conditions like colitis, inflammatory bowel disease and diverticulosis. A colonoscopy is a procedure to examine the inside of your colon (intestine) with a scope. To learn more, please visit our. Taking care of your colon requires more than just regular screenings. eat organic. Smoking before surgery puts you at a higher risk for postoperative heart attacks, blood clots, pneumonia and even death, says pulmonologistHumberto Choi, MD. You also have the option to opt-out of these cookies. In general, it is advisable not to smoke after an endoscopy, at least not immediately because the effect of sedatives can take several hours to completely wear off. Get prescriptions or refills through a video chat, if the doctor feels the prescriptions are medically appropriate. Answer (1 of 23): Nothing out of the ordinary. Do you think it will be an issue? Othernecessary carethat the patient should consider once discharged are: This article is merely informative, at FastlyHeal .com we do not have the power to prescribe medical treatments or make any type of diagnosis. Advertising on our site helps support our mission. That being said, I would by no means risk my life to find out and I would never smoke before any procedure. Would you like email updates of new search results? If you are not going to meet with your anesthesiologist, then tell your doctor or nurse or whoever is performing the procedure. You may brush your teeth, but do not swallow. Other helpful tips include: Making sure the e-cigarette is working properly with a clean air intake and functioning coil. Smokers face twice the risk of developing pneumonia. When I schedule surgery, I tell my patients they should stop smoking right away.. We also use third-party cookies that help us analyze and understand how you use this website. For these, please consult a doctor (virtually or in person). Smoking affects the safety of anesthesia but 2 cigarettes 48 hrs before a breast augmentation is a non-event. From MMJ to munchies, from nugs to news, and everything between! If you have allergies to aspirin, your doctor may advise you to stop taking it before the procedure. This cookie is set by GDPR Cookie Consent plugin. It complicates anesthesia. This includes cigarettes, pipes, cigars, e-cigarettes and other substances. There are only three operations that plastic surgeons refuse to do on smokers: Face Lift, Breast Lift and Tummy Tuck. Save you an average of $1,400 a year. "i've had 3 colonoscopies over the last 15 years. non-smoker, non-drinker, normal weight. Lost craving for sweets after colonoscopy. Of course if you have any symptoms like recta Agree with Dr. L. An additional precaution you may take would be to get a FIT test once a year. no polyps. If you have a history of smoking, your doctor may ask you to stop smoking before your procedure. Advertising on our site helps support our mission. Less than 10 percent of all colon cancer is based on heredity. do i need a colonoscopy screening even if i don't have symptoms? What happens if you have nicotine in your system before surgery? If you have any of the following, your doctor might allow you to have a bowel movement during the procedure: Your doctor might also ask you to have a stool sample taken during the procedure. I am having an endoscopy tomorrow. (2012). Hello No cigarette smoking will not affect the exam/colonscopy. Necessary cookies are absolutely essential for the website to function properly. Also you don't want to smoke before an endoscopy, I believe it's the same prep as a colonoscopy, so your ass is gonna feel awful and you're gonna be starving. Policy. I am just wondering if it's ok to smoke now? Colonoscopy prep diet. Hossain MS, Karuniawati H, Jairoun AA, Urbi Z, Ooi J, John A, Lim YC, Kibria KMK, Mohiuddin AKM, Ming LC, Goh KW, Hadi MA. Out of these, the cookies that are categorized as necessary are stored on your browser as they are essential for the working of basic functionalities of the website. Fasting for 4 to 12 hours before the procedure.

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can i smoke cigarettes after a colonoscopy