Colonoscopy Options and Patient Preference

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Colorectal cancer is the second leading cause of cancer deaths in the United States, after lung cancer. If you have no history of smoking or exposure to industrial chemicals, then colorectal cancer may be your number one cancer risk. This is why you should consider a colonoscopy for early detection and treatment. Advances in the technique have made this screening much more tolerable than it was originally.

Sedation is now standard for optical colonoscopy in the United States. All I felt was the small needle stick for the intravenous line. The next thing I knew, my friend was there to take me home and the doctor was telling me all was OK, come back in 10 years. No problem!

It's the preparation that most people still object to. The colon has to be empty for the procedure to be successful. Over the years, researchers have developed gentler methods to accomplish this. You can start a low-fiber diet up to a week in advance, then shift to softer foods and then liquids. The laxatives then get you “cleaned out”. You probably need two days off from work: one to stay home and prepare, then another to recuperate from the sedation.

There are some options for both preparation and anesthesia. As in dentistry, some patients want more anesthesia and are willing to feel drowsy for the rest of the day; others are willing to tolerate some discomfort in order to recover faster.

There is also an option to get the screening done by X-ray instead of the more invasive endoscope. A research team in The Netherlands studied patient preferences for CT colonography (the X-ray version) with limited bowel preparation, versus optical colonoscopy with cathartic bowel preparation. All participants received both procedures. Overall, 69 percent preferred the CT method, and 22 percent preferred the conventional optical colonoscopy.

The participants who preferred the CT colonography said the main reason was the difference in preparation procedures. The researchers reported good results using milder laxatives along with contrast agents for the X-ray procedure.

The participants who preferred optical colonoscopy said the main reason was the ability for the doctor to remove polyps in the same procedure. I expect more patients would have preferred optical colonoscopy if they had received sedation equivalent to what I got. In the study reported, 82 percent of patients were mildly sedated, but they still reported pain from the movement of the endoscope.

Ask your doctor about options for you.

Reference:

Bipat JS et al, “CT colonography with limited bowel preparation: prospective assessment of patient experience and preference in comparison to optical colonoscopy with cathartic bowel preparation”, Eur Radiol. 2010 Jan; 20(1): 146-56.

Linda Fugate is a scientist and writer in Austin, Texas. She has a Ph.D. in Physics and an M.S. in Macromolecular Science and Engineering. Her background includes academic and industrial research in materials science. She currently writes song lyrics and health articles.

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We value and respect our HERWriters' experiences, but everyone is different. Many of our writers are speaking from personal experience, and what's worked for them may not work for you. Their articles are not a substitute for medical advice, although we hope you can gain knowledge from their insight.