News from Digestive Disease Week 2008

A tiny microscope, less than one-sixteenth of an inch, attached to the end of the instrument used for a colonoscopy can provide magnified pictures of cells and small blood vessels in suspicious lesions allowing doctors to make on-the-spot decisions about whether a polyp is benign or precancerous.

The technique — confocal endomicroscopy — can identify benign polyps 98 percent of the time, avoiding having to remove the lesion and wait for results of the biopsy.  Precancerous polyps can be viewed, identified, and treated immediately during the colonoscopy. Read the rest of this entry »

News from Digestive Disease Week 2008

Video courtesy of Medscape Today.

The first colonoscopy performed each day finds more polyps — both small hyperplastic ones and more serious advanced adenomas.  As the day goes on, fewer polyps are found every hour.

Researchers studied all the colonoscopies performed at the UCLA Veteran Administration Center in 2006 and 2007, keeping track of a number of variables that might affect the number of polyps found.  Even adjusting for patient differences, withdrawal times, and bowel preparation, the time of day remained a predictor of how many polyps were located during the colonoscopy. Read the rest of this entry »

After it’s over, everyone will tell you, “The prep’s the hardest part.”

For the best results, the colon needs to be absolutely clear of stool (bowel movements, feces).  Small or flat polyps or nonpolypoid colorectal neoplasms (which are both flat and depressed) can hide under stool.  Poor preparation may require that the colonoscopy be repeated on another day or that important polyps will be missed.  All preps will produce large volumes of watery diarrhea.

So, even if it’s tough, it’s important.  If you have trouble finishing your prep, call your doctor right away so something else can be suggested.

Most colonoscopy preps begin with clear liquids the day before the procedure.  No milk or dairy products, but water, clear juices, ginger ale, tea, jello, clear broth, or sports drinks are fine.  It’s important not to drink anything red since the dye may conceal a problem in the colon.

Before your colonoscopy let your doctor know about any kidney or cardiac problems you have since some sodium phosphate preps (Visicol®, or OsmoPrep®) may have serious side effects on the kidneys.  The elderly may have more difficulty with dehydration or electrolyte unbalance.

Talk over what the best prep might be for you with your doctor.  Remember the best prep is one you can finish.

• Will it be difficult for you to drink large volumes of liquid that may not taste very good?
• Are pills hard for you to swallow?
• Do you have cardiovascular or kidney problems?
• Do you have insurance coverage for a prescription or would an over-the-counter prep be better?

Colonoscopy prep choices include:

• High volume polyethylene glycol (PEG) solutions of up to 4 liters of fluid.  An 8 ounce glass is drunk rapidly every ten minutes.  PEG preps also include sodium and potassium salts to replace electrolytes lost during extensive watery stools.  PEG preps include GoLytely®, NuLytely®, and Colyte®.
• Miralax® is a PEG powder that may be mixed with 2 quarts of clear Gatorade.
• MoviPrep® is a lower volume liquid prep that combines PEG,  sodium and potassium salts, and ascorbic acid (vitamin C).  It is lemon-flavored, provided in two pouches that are mixed in 1 liter of water.  It can be refrigerated for up to 24 hours which may make it easier to take.
• LoSo Prep™ is based on magnesium citrate and avoids high amounts of sodium.
• Prescription pill formulations of sodium phosphate including Visicol™ and OsmoPrep®.  Both require that 32 to 40 tablets be taken with clear liquids over a period of time.  Your doctor will provide the schedule for taking the pills.
• Over-the-counter Fleet’s Phospho-soda is no longer on the market.

The latest information from gastroenterology research shows that the best prep may be one that is split between two days — the day before your colonoscopy and the day of the procedure.

Tips from Friends

Here are some ideas from fellow patients to make things easier.

• Prepare by having 3 to 4 quarts of clear liquids on hand and include some jello and broth to feel like real food.
• If your prep is liquid, keep it very cold and use a straw.
• Avoid a sore bottom with extra soft toilet tissue and baby wipes (no alcohol). Pat dry gently.
• Consider staying in the bathroom with something to read rather than racing back when the urge to go is strong.
• Plan your prep time so you get a good night’s sleep.
• Drink, drink, drink — but not only water.  Sports drinks can replace lost electrolytes and sugar so you won’t feel so wobbly the next day.

Evidence from the National Polyp Study has shown clear evidence that removing adenomas (polyps) during a colonoscopy reduces risk for colorectal cancer significantly. There were more than 1,400 patients in the study who had colonoscopies and all existing polyps removed. After an average of six years, only five people developed colorectal cancer, all at an early stage. None died.

A colonoscopy allows the doctor performing the test to see the entire colon from the anus to the cecum and remove polyps.

The colonoscope is a thin, long, flexible instrument with a lighted lens or video camera at its end. Instruments to remove polyps or take samples of tissues for biopsies can be introduced through the scope. During colonoscopy, the scope is inserted carefully through the rectum and guided through the colon. Mayoclinic.Com has a video of a colonoscopy that illustrates the procedure.

Physicians who perform colonoscopies are usually gastroenterologists, but may be surgeons or, sometimes, specially trained family physicians. Locate a gastroenterologist who is a member of the American College of Gastroenterology or a find a member of the American Society for Gastrointestinal Endoscopy.

What’s the Procedure Like?

Before the colonoscopy begins, an IV needle will be put in your hand or arm for medicines to make you feel relaxed and sleepy. Most patients will have no pain during the procedure and will probably not remember the colonoscopy itself. If there is pain, additional medicine can be added to the IV. Patients with special needs may have an anesthesiologist present to administer deeper sedation. However, most colonoscopies are completed with moderate sedation administered by the endoscopist.

After your colonoscopy, you’ll need to rest for an hour or two in the recovery area until the sedatives have worn off. During this time, you will probably have to pass gas from air that was inserted during the procedure so the lining of the colon could be seen clearly. You will need someone to drive you home, but you’ll be able to return to your regular activities the next day.

Because the lining of the colon must be completely clean to provide the best view, bowel preparation the day before the colonoscopy is important. A clear liquid diet and strong laxatives will be prescribed for you. The laxatives will produce a great deal of watery diarrhea. Here’s more information on colonoscopy preps.

Depending on what is found during your colonoscopy, your doctor will recommend the right time for a follow-up colonoscopy. If cancer is discovered, you’ll be referred to a surgeon or medical oncologist for treatment.

Although it is rare, call your doctor immediately if you have severe abdominal pain, fever, bloody bowel movements, or dizziness or weakness after your colonoscopy.

Colonoscopy is not without risk. In a very,very small percentage of colonoscopies, the scope may make a hole (perforation) in the colon. There are also risks from sedation and from the preparation to consider.

Where Can You Go for More Information?

Audio and Slide Presentation: Sidney J. Winawer, lead author for the National Polyp Study, discussed The Role of Colonoscopy and Polypectomy in the Prevention of Colorectal Cancer during the AACR Frontiers in Cancer Prevention Research conference in December, 2007.

National Digestive Diseases Clearinghouse: Colonoscopy

Video of Katie Couric’s colonoscopy in 2000, credited for the “Couric Effect” that increased use of screening colonoscopy. Note: Katie is perhaps more awake and alert that most people would be. She says she wanted to be awake enough to ask questions during the taping.

American Society for Gastrointestinal Endoscopy has answers to many patient questions about colonoscopy on their site Screen4ColonCancer.Org.

Have a friend whose reached a fiftieth birthday? Send an email greeting card reminding them that screening prevents colorectal cancer.