Therapeutic colonoscopy can be used to address several gastrointestinal issues including lower acute gastrointestinal bleeding, obstruction, polyps, inflammatory bowel disease, tumors, and fistulas. The colonoscopy allows for procedures like snaring polyps, stenting tumors, treating angiodysplasia, and extracting foreign bodies. However, colonoscopy is not recommended in cases of colonic perforation, leakage, secondary peritonitis, or most cases of obstruction. It can also be used for conditions like familial polyposis, unexplained anemia, or evaluation of hepatic lesions.

1. Therapeutic Colonoscopy

2. Lower Acute GIT bleeding
 PR must precede colonoscopy
 Preparation
 Small intestine (10%, blind)
 Colon (Angiodysplasia, Diverticulosis)
 Angiography
 CT angiography
 Others
 No barium

3. Intra-Operative Endoscopy

4. Obstruction
 Limitations and complications
 Stenting tumours up to sigmoid
 Untwisting volvulus

5. Polyps
 Snaring
 Preservation of rectum in total colectomy

6. Infammatory bowel disease
 Follow-up (complications)
 Deompression in acute dilatation

7. Tumours
 Distance from anal verge
 Associated polyps (Extent of resection /
polypectopy)
 Synchronous tumours
 Anastomotic recurrence / stricturing
 Tumour / Anastomotic bleeding
 Before reversal of Hartmann’s procedure
 Differentiation from other diseases

8. Fistula
 Recto vaginal fistula: Mass, from which?
 Biopsies
 Not very useful for colovesical

9.  Foreign body extraction
 Ablation of angiodysplasia
 Pre-operative marking
 NOTES

10. Do not do colonoscopy
 Colonic perforation / leakage
 Secondary peritonitis
 Most cases of obstruction

11. Do colonoscopy without colonic
symptoms
 Familial polyposis
 Inguinal hernia for first time in the elderly
 Iron deficiency anemia with no apparent
cause
 Hepatic focal lesion indefinitely hepatoma