Colonoscopy – It’s not so scary!

March 23, 2016 Harry L. Teicher, M.D.

As you may know (or if you don’t just tune in Katie Couric and she’ll remind you), March is National Colorectal Cancer Awareness Month. In a month full of days such as National Clams on the Half Shell day, National Peanut Butter Lover’s Day and National Ravioli Day, it’s hard to measure up.

As you may also know, screening for colorectal cancer starts for most people at age 50 (sooner for people with a family history of colon cancer or some other cancers, and for African Americans; your care provider can provide more on this.) Usually, people who hit the big 5-0 are more concerned with the type of party they’ll have or the cool trip they’ll take, than with having to do “that thing with that nasty drink that made Uncle Fred puke and he will NEVER do that again!”

Don’t listen to Uncle Fred

In reality, there are very few Uncle Freds. The large majority of people tolerate this lifesaving screening test very well without any issues whatsoever and thus prevent themselves from getting this common disease, which often has no symptoms until it is advanced.

In the United States, colorectal cancer is the third-most common cancer diagnosed among women and men and is the second-leading cause of death from cancer.  However, this cancer is largely preventable by finding and removing adenomatous polyps in the colon. These polyps do not usually cause any symptoms, and the best way to find and remove them is to have a colonoscopy.

Peace of mind

Removing polyps reduces your risk of colorectal cancer to a very great degree. If colorectal cancer is found while still localized to the colon, five-year survival is 90 percent. Also, if you are at average risk for colorectal cancer and your colonoscopy is normal, then colonoscopy is the only cancer screening test that offers 10 years of protection and peace of mind.

The risks of complications from a colonoscopy are very small. The most serious complication is perforation, a hole in the colon caused by the scope. Surgery may be required to fix the hole. Although the literature quotes a rate of 1 in 1,000 for perforation, the rates for the endoscopists at Swedish are far, far lower. And the risks of having bleeding after a polyp is removed are also extremely low.

Why choose colonoscopy?

There are other screenings, such as stool tests, barium enemas and CT colonography, but none of these is as good as a colonoscopy for seeing all polyps.

CT colonography often is not covered by insurance. And if one of these other screenings is positive, colonoscopy is indicated anyway.

(As an aside, study after study has shown that for most patients CT colonography is more uncomfortable than colonoscopy—and you still have to do a prep!)

Uncle Fred and the facts

So why do so many people refuse colonoscopies and not get screened? Does everyone have an Uncle Fred (mine were Sam and Jack)?

Let’s look at the reasons people give for opting out.

1) That prep is horrible. I can’t do it. Uncle Fred said it was THE WORST!

Preparing for a colonoscopy is not fun:

  • You do not get to eat solid food.
  • You have to spend a lot of time in the bathroom.
  • You usually have to prep in two stages, and you get up really early for the second stage.

But it is ONE DAY. Think of it as a very small investment for probably many years of peace of mind. You can also mix the prep with ginger ale or Sprite or Gatorade or other clear liquids of your choice so it is not so displeasing (vodka and tequila may not be the best idea here).; And if you can’t get that last glass down but it’s running clear down below, congratulate yourself and take a pass. Most people who have heard the stories about “chugging the gallon” do not have to drink that much prep at one time, and they find it isn’t as bad as they thought.

2) Uncle Fred said it hurt. And they didn’t put me all the way out!!

Conscious sedation is offered to most people for their colonoscopy. This is because for most people the procedure can be uncomfortable. Short-acting medications are given to ease the discomfort, but you are not under general anesthesia (intubated or receiving propofol with need for an anesthesiologist). There are people who can do this without sedation (myself included).

Having had my own procedure without sedation, I did feel a couple of cramps. But overall, it worked well for me. There are people who will need general anesthesia for their colonoscopy, but this number is very small and usually limited to those who are on chronic pain medications for other reasons. We cannot promise that everyone will feel absolutely nothing, but the most common comment we hear after we start is: “You’re done? No way!”

3) Uncle Fred heard that those scopes are infected!

In the last couple of years, there have been several reports of infections associated with specialized endoscopic procedures called ERCP. This has left some people reluctant to have any endoscopic procedure at all. The news media have not helped clear the confusion.

The scope used for an ERCP has a separate and specific channel that is hard to clean and is NOT found on the scopes used for colonoscopy. And these infections have never been transmitted endoscopically at Swedish. So you can rest assured that this is not a possible outcome from your colonoscopy.

Time to get checked

Of course, we are available anytime for any questions or concerns you may have before or after your colonoscopy.

Like many things in life, the anticipation is often worse than the reality. Do yourself and your loved ones a favor and get yourself checked.

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