THURSDAY, May 30 (HealthDay News) -- Let's face it: the very
mention of the word "colonoscopy" is enough to make many people
shudder, at least a bit. But, colonoscopy is an extremely effective
cancer screening tool, and it's the only cancer screening that can
actually prevent cancer from developing in the first place because
doctors can remove precancerous polyps during the test.
Most people who've had a colonoscopy say the test itself is no
big deal. It doesn't take a lot of time, and you're sedated.
What people really don't like, however, is the colon-cleansing
preparation that's required before the test. People who've had a
colonoscopy often say that the prep is the worst part of the whole
However, it's a crucial part of the procedure. If the bowel
isn't thoroughly cleaned out, doctors might miss a pre-cancerous
polyp during the colonoscopy because they simply can't see it.
"I've had patients tell me the prep was cruel and unusual punishment, but it clears the colon wall so we can identify polyps," said Dr. Grant Hutchins, a gastroenterologist at the Nebraska Medical Center in Omaha.
Dr. Pankaj Vashi, the national clinical director of
gastroenterology and nutrition at the Cancer Treatment Centers of
America in Chicago, agreed. "We're looking for very small lesions,
from 3 millimeters to 1 centimeter," he said. "If the colon isn't
completely cleaned out, we can potentially miss small polyps. It's
a crucial thing to have a cleaned-out colon."
A 2012 study from the journal
Gastrointestinal Endoscopyfound that as many as a third of
polyps are missed when people fail to adequately prepare for their
So, why are some people short-changing their bowel
Some find that the necessary volume of liquid is difficult to
drink, and some people balk at the taste of some of the preparation
solutions, according to Hutchins.
In the past, colonoscopy preparation required drinking an entire
gallon of a salty solution the night before the procedure. Today,
most preparations require half that volume, Vashi said. Hutchins
noted that minor flavoring has been added to some preparation
solutions to make them more palatable.
Pills are now an option, though they must be consumed with
liquids, and the standard prep relies on taking 32 pills, according
to Vashi. Researchers are working on developing options with fewer
tablets. Another option is to take the over-the-counter laxative
MiraLAX, along with 64 ounces of a sports drink, such as Gatorade.
It's also possible to split the preparation, doing half the night
before and half in the morning, five hours or so before the
Most doctors have a method that they prefer and will recommend.
But if you've tried a particular method in the past and know you
don't like it, ask your doctor what other options are
Whatever method of preparation is used, the goal is to induce
diarrhea to clean out your bowels. So, plan to spend a lot of time
in the bathroom. And to make the process as comfortable as
possible, it's a good idea to buy flushable moist wipes.
Preparation also requires that you fast the day before the
procedure, consuming only a clear liquid diet that doesn't contain
any red or purple coloring, according to Hutchins. Examples of
liquids that are OK to consume are water, apple juice, ginger ale,
jello and clear broth.
People hoping to avoid the preparation by having a virtual
colonoscopy -- a test that uses CT scanning technology to capture
images of the bowel -- are out of luck. The virtual colonoscopy
still requires bowel preparation, though researchers at the Mayo
Clinic have come up with a new technique that requires just four
cleansing tablets before a virtual colonoscopy. Also, Harvard
researchers have developed a preparation that involves putting a
contrast medium into low-fiber foods and snacks for two days before
the test. The contrast agent makes fecal matter stand out on the
scan, making it easy to remove from the image.
The drawback to virtual colonoscopy, however, is that if a polyp
is found, you'll still need to undergo a regular colonoscopy.
Some researchers are hoping to develop screening tests that can
bypass the colonoscopy altogether. A company called Exact Sciences
has indicated that it intends to seek U.S. Food and Drug
Administration approval for a noninvasive, DNA-based stool test it
has developed. It's designed to detect changes in DNA that indicate
cancerous or pre-cancerous changes. Of course, if cancerous changes
were detected, you'd still need to have a colonoscopy.
Both Hutchins and Vashi said that cleaning out the bowel before
colonoscopy will probably be a necessary part of the procedure for
some time to come.
"We've come a long way already, and while we do keep on trying to make it easier for patients, we don't want to compromise the quality of the bowel preparation and the colonoscopy," Vashi said.
The American College of Gastroenterology has more about
bowel preparation and the colonoscopy procedure.
For more on the
risks of delaying a colonoscopy, read about one man's experience.
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