Reading your coloscopy report, line by line
In short
A coloscopy report is written for other clinicians, so it is short, dense, and full of shorthand. Most of it describes how well the examination went: how clean the bowel was, how far the scope reached, and how long the endoscopist spent looking. The rest lists what was seen, what was done about it, and when you should come back. Many common lines, such as diverticulosis, small haemorrhoids, a hyperplastic-looking polyp or a tortuous colon, are routine. The line that matters most for your future is usually the recommendation at the end, and that line is often provisional until the pathology comes back.
What this page covers
- How a typical report is laid out
- The quality lines: prep score, caecal intubation, withdrawal time
- How findings are described: location, size, shape
- What was done: biopsy, snare, clips, tattoo
- Common incidental findings, translated
- The recommendation line, and why it may change
How a typical report is laid out
Layouts differ between units and software systems, but nearly every report contains the same blocks, usually in this order:
- Indication. Why the test was done. For example: screening, positive FIT, surveillance after previous adenomas, rectal bleeding, change in bowel habit, iron-deficiency anaemia. This line also decides how the procedure is billed in some countries (see screening, diagnostic, and surveillance).
- Sedation. What was given, and sometimes the doses. For example, midazolam and fentanyl, propofol, Entonox, or none.
- Extent and quality. How far the scope reached, how clean the bowel was, and how long the withdrawal took.
- Findings. Each finding, segment by segment, often with photographs.
- Interventions. Biopsies, polyp removal, clips, tattoo.
- Impression or diagnosis. A one- or two-line summary.
- Recommendations. Await pathology, restart medications, repeat interval, referrals.
The quality lines
These lines tell you how much to trust a normal result. A normal report with an excellent prep and a complete examination is reassuring. A normal report with a poor prep is less so.
Bowel preparation scores
Most units grade cleanliness with a named scale.
| What you might read | What it means |
|---|---|
| Boston Bowel Preparation Scale (BBPS) 9, or 3-3-3 | Each of three segments (right, transverse, left) is scored 0 to 3. A total of 6 or more, with no segment below 2, is generally regarded as adequate. A 9 is perfect. |
| Aronchick: excellent / good / fair / poor / inadequate | A whole-colon impression. Excellent and good are adequate. Fair is often adequate. Poor and inadequate usually mean the test needs repeating sooner. |
| Ottawa score | A scale on which lower is better. Your clinician will say whether the result was adequate. |
| "Adequate to detect polyps larger than 5 mm" | A plain-language summary used by some units and recommended by quality bodies. Small lesions may have been missed, but anything significant would very likely have been seen. |
| "Residual fluid suctioned", "murky fluid", "washing required" | Some liquid was left, and the endoscopist cleared it. This is common and does not on its own mean the prep was poor. |
| "Solid stool in caecum", "views limited" | Parts of the lining could not be seen. Check whether the report recommends an earlier repeat. |
For what each level looks like at home before you leave, see how to tell the prep has worked.
Extent: did the scope reach the end?
- "Caecum reached", "complete to caecum", "caecal intubation": the whole colon was examined. Look for the landmarks that prove it: the ileocaecal valve and the appendiceal orifice, which are often photographed.
- "Terminal ileum intubated": the scope went a short way into the small bowel, often to look for Crohn's disease or as extra proof of completion.
- "Incomplete to hepatic flexure", "examined to 60 cm": the scope did not reach the caecum. The reason is usually given: looping, discomfort, a narrowing, or a poor prep. See when a coloscopy is incomplete or must be repeated.
- "Tortuous" or "redundant" colon: a longer or more looped bowel than average. It is a description, not a disease.
- "Retroflexion in the rectum performed": the scope was turned back on itself to look at the lowest part of the rectum. This is often where internal haemorrhoids are noted.
Withdrawal time
"Withdrawal time 9 minutes" means the endoscopist spent nine minutes examining the lining on the way out. Quality standards set a minimum of six minutes for a screening examination with no polyps removed, and many units now aim for longer. Time spent removing polyps is often excluded. For other quality measures, see judging the quality of a coloscopy.
How findings are described
Location
Findings are named by segment: rectum, sigmoid, descending colon, splenic flexure, transverse colon, hepatic flexure, ascending colon, and caecum. Many reports also give a distance, such as "polyp at 25 cm". This is the length of scope inserted, measured from the anus, at the moment the finding was seen. The colon concertinas over the scope, so these distances are approximate except in the rectum and lower sigmoid. They are useful for finding the same spot again. They are not precise anatomy. The anatomy page shows how the segments fit together.
Size
Polyps are measured in millimetres, usually by comparing them with the open snare or biopsy forceps. The bands that matter for follow-up are:
- Diminutive: 5 mm or smaller. Very common, and very rarely cancerous.
- Small: 6 to 9 mm.
- Large: 10 mm or more. A 10 mm or larger adenoma counts as advanced and usually shortens the surveillance interval.
- 20 mm or more: usually removed in pieces (piecemeal) and checked again within months.
Shape
| On the report | Plain English |
|---|---|
| Pedunculated, Paris 0-Ip | On a stalk, like a mushroom |
| Sessile, Paris 0-Is | A raised dome with no stalk |
| Semi-pedunculated, 0-Isp | Between the two: a broad, short neck |
| Flat, slightly elevated, 0-IIa | Only slightly raised. Often harder to see. |
| Depressed, 0-IIc | Slightly sunken. This is less common and gets extra attention, sometimes with biopsy before planned removal. |
| Laterally spreading tumour (LST) | A flat lesion of 10 mm or more that grows sideways along the wall rather than upwards. "Granular" and "non-granular" describe its surface. The word tumour here means a growth. It does not mean cancer. |
| NICE type 1 / 2 / 3, JNET | Classifications made under narrow-band imaging that predict what the pathology will show. Type 1 suggests hyperplastic or serrated, type 2 suggests adenoma, and type 3 raises concern for deeper invasion. |
For what the polyp types themselves mean, see polyp types in plain English.
What was done
| On the report | What it means |
|---|---|
| Cold snare polypectomy | The polyp was removed with a wire loop and no electrical current. This is the standard method for small polyps and has a low bleeding risk. |
| Hot snare, diathermy | A wire loop with electrical current. It is often used for larger or stalked polyps. |
| Cold forceps, biopsy forceps | Removed or sampled with small cupped jaws. This is used for tiny polyps or to take samples of tissue. |
| EMR (endoscopic mucosal resection) | Fluid was injected under a flat or large polyp to lift it before removal. |
| ESD (endoscopic submucosal dissection) | A specialist technique that cuts a large lesion out in one piece. It is done in expert centres. |
| En bloc / piecemeal | Removed in one piece, or in several pieces. Piecemeal removal usually means a check of the site in about six months. |
| Retrieved / not retrieved | Whether the removed tissue was recovered for the lab. Tiny polyps are sometimes lost in suction. This is not usually a cause for concern, but it can affect the follow-up interval. |
| Clips placed, haemostasis achieved | Small metal clips were used to close the site or stop bleeding. They fall off and pass naturally within days to weeks. |
| Tattoo, SPOT, India ink | A permanent ink mark was placed in the wall near the lesion so the site can be found again by a later endoscopist or a surgeon. |
| Biopsies taken, random biopsies | Tissue samples were taken from the lining. Random biopsies from normal-looking lining are standard when chronic diarrhoea is being investigated (to look for microscopic colitis) and in colitis surveillance. |
If you had a polyp removed, after polyp removal covers bleeding, blood thinners, and what to expect over the following two weeks.
Common incidental findings, translated
These lines show up often. In most cases they need no action.
| On the report | Plain English |
|---|---|
| Diverticulosis, diverticula, sigmoid diverticular disease | Small pouches in the bowel wall. They are very common with age and are usually harmless. See diverticulosis. |
| Internal haemorrhoids, grade I | Swollen veins just inside the anus, seen on retroflexion. They are very common. See internal haemorrhoids. |
| Melanosis coli | Brown pigmentation of the lining, usually from long-term use of senna-type laxatives. It is harmless and fades if the laxative is stopped. |
| Lipoma | A soft, yellowish lump of fat under the lining. It is benign and is usually left alone. |
| Hyperplastic-appearing polyp in the rectum | A small, pale polyp that is usually harmless. It is sometimes left or removed without being sent to the lab, depending on local policy. |
| Normal mucosa, no inflammation | The lining looked healthy. |
| Erythema, mild proctitis | Redness or mild inflammation. Sometimes this is caused by the prep itself, and sometimes it is biopsied. |
| Anal fissure, skin tags | A small tear, or folds of skin, at the anus. These are common and benign. |
| Ileocaecal valve lipomatous | A fatty-looking valve. This is a normal variant. |
The recommendation line
The last lines usually say one of a few things:
- "Repeat coloscopy in 10 years": a normal screening examination with an adequate prep.
- "Await histology; surveillance interval to be determined": polyps were removed, and the interval depends on what the lab finds. Expect a letter or a call. See how and when you get your results.
- "Repeat in 1 year due to suboptimal prep" or "repeat with extended prep": the examination was not good enough to rule out significant polyps.
- "Site check in 6 months": a large polyp was removed in pieces, and the scar will be inspected.
- "Refer to colorectal MDT" or "CT staging": something needs more assessment. Your team should contact you quickly. If you have not heard within a week or two, call.
The interval written on the day is often provisional. The pathology result, especially the number, size, and type of polyps, decides the final plan. See surveillance intervals.
What to ask your clinician
- Was the prep adequate everywhere, including the right side?
- Did the scope reach the caecum?
- How many polyps were removed, how large were they, and were they all retrieved?
- Were any removed in pieces, and do I need a site check?
- Is the repeat interval on this report final, or will it change after pathology?
- Who will send me the pathology result, and by when?
- Is there anything on this report that I should mention to my GP or primary-care clinician?
Common worries, briefly addressed
The report uses the word "lesion." Does that mean cancer?
No. "Lesion" is a neutral word for anything abnormal, including a tiny harmless polyp. "Laterally spreading tumour" is similar: tumour there means a growth, not a cancer.
The report says "polyp not retrieved." Should I worry?
Usually not. Small polyps sometimes cannot be recovered from the suction trap. Your clinician will decide the interval as if it were the more significant type, which may bring the next test forward slightly.
Why does the report give distances in centimetres that do not match the anatomy diagrams?
The distance is the length of scope inserted, not a ruler measurement along the bowel. Loops and the concertina effect make it approximate above the rectum. The named segment is the more reliable location.
The report says "small internal haemorrhoids." I had no idea I had them.
That is very common. Most internal haemorrhoids cause no symptoms. They are noted because they are seen, and they need no treatment unless they bleed or bother you.
My report and my pathology report seem to disagree.
The endoscopist describes what the polyp looked like. The pathologist reports what it is under the microscope. When they differ, the pathology result takes precedence. See reading the pathology report.
Sources
- U.S. Multi-Society Task Force on Colorectal Cancer: recommendations on bowel preparation, quality indicators, and follow-up after colonoscopy and polypectomy
- American Society for Gastrointestinal Endoscopy and American College of Gastroenterology: quality indicators for colonoscopy
- European Society of Gastrointestinal Endoscopy: performance measures for lower gastrointestinal endoscopy; colorectal polypectomy and EMR guideline
- British Society of Gastroenterology, Association of Coloproctology of Great Britain and Ireland, and Public Health England: post-polypectomy surveillance guidelines
- Paris endoscopic classification of superficial neoplastic lesions
- Lai EJ et al. The Boston Bowel Preparation Scale: a valid and reliable instrument for colonoscopy-oriented research