Therapeutic colonoscopy is a colonoscopy performed not just to look inside the colon, but to treat problems during the same procedure. Using the colonoscope’s working channel, the endoscopist can pass instruments (snares, clips, injection needles, cautery devices, balloons, stents, retrieval nets) to remove lesions, stop bleeding, open narrow areas, or relieve obstruction—often avoiding surgery.

What makes a colonoscope “therapeutic”

A colonoscope is a flexible tube with a camera, but its therapeutic power comes from:

• A working channel for instruments

• Ability to insufflate (CO₂/air) and wash/clear the field

• High-definition imaging (often with enhancement modes) for precision

• Real-time control of bleeding and tissue manipulation

Main therapeutic uses

1) Polyp removal (polypectomy) and cancer prevention

This is the most common therapeutic use. Many colorectal cancers start as polyps, so removing them reduces future cancer risk.

• Cold snare polypectomy (often used for small polyps)

• Hot snare polypectomy (uses cautery for selected cases)

• Endoscopic mucosal resection (EMR) for larger flat lesions

• Endoscopic submucosal dissection (ESD) (advanced, in specialized centers) for selected early cancers/large lesions

After removal, tissue is sent to pathology to determine if margins are clear and if further treatment is needed.

2) Control of lower GI bleeding (hemostasis)

Therapeutic colonoscopy can treat bleeding from:

• Post-polypectomy sites

• Diverticular bleeding

• Angiodysplasia

• Ulcers/inflammation (selected cases)

Hemostasis methods include:

• Injection (e.g., dilute epinephrine as a temporary measure)

• Thermal therapy (coagulation)

• Mechanical therapy: clips (common), banding in selected rectal lesions

• Topical hemostatic agents/powders in some centers

3) Treatment of strictures (narrowing)

Strictures may be due to inflammation (IBD), surgery, radiation, or cancer.

• Balloon dilation can improve stool passage and symptoms

• Intralesional injection (sometimes used in selected benign strictures)

• Stent placement (typically for malignant obstruction or as a bridge to surgery)

4) Decompression procedures

• Volvulus decompression (especially sigmoid volvulus): the scope can untwist and decompress the colon, sometimes with placement of a rectal tube afterward.

• Acute colonic pseudo-obstruction (Ogilvie’s syndrome): colonoscopic decompression may be used when conservative/medical management fails (center-dependent).

5) Foreign body retrieval

Objects in the rectum/colon can sometimes be removed endoscopically using snares, forceps, or nets—depending on size, shape, and risk of injury.

6) Treatment of chronic radiation proctopathy (selected)

For chronic bleeding from radiation injury in the rectum, endoscopic therapies (commonly coagulation techniques) can reduce bleeding in selected patients.

Benefits of therapeutic colonoscopy

• Minimally invasive: avoids or delays surgery in many cases

• Same-session diagnosis + treatment

• Faster recovery and shorter hospital stays

• Cancer prevention via polyp removal

Risks and complications

Therapeutic procedures have higher risk than purely diagnostic colonoscopy. Key risks include:

• Bleeding (immediate or delayed, especially after polypectomy/EMR)

• Perforation (higher with dilation, EMR/ESD, severe colitis)

• Post-polypectomy electrocoagulation syndrome (burn injury without full perforation)

• Infection (uncommon but possible)

• Sedation-related complications

Risk is reduced by good bowel preparation, careful technique, appropriate device selection (e.g., cold snare for small lesions), and proper post-procedure instructions.

Conclusion

Therapeutic colonoscopy is a cornerstone of modern GI care because it turns colonoscopy into an intervention—removing precancerous polyps, stopping bleeding, dilating strictures, decompressing volvulus, and sometimes placing stents. By treating disease through a minimally invasive approach, it improves outcomes and often prevents the need for more invasive surgery.