If you’re in a conversation where the subject is colonoscopies, you’ll hear how one group dislikes the day of the procedure, but another -- probably larger -- group dislikes the day before, when you must undertake colon cleansing to the max. In fact, some people dislike it so much that their failure to do it properly leads to the cancellation of the procedure.
If you knew that inadequate bowel cleansing meant that doctors often miss precancerous polyps (adenomas), would you do better prep before the big day?
Even Dr. Mehmet Oz of TV fame was guilty of poor prep for his 50th-birthday colonoscopy when he thought he could get away with a little bit of lunch instead of fasting for 36 hours. He detailed his procedure and his wake-up call to be a better patient in a June 2, 2011, Time magazine article, “What I Learned from My Cancer Scare.”
Inadequate bowel cleansing can easily make a colonoscopy less effective in searching out polyps and can sometimes result in a follow-up colonoscopy within just one year, said Dr. Benjamin Lebwohl of Columbia University Medical Center in New York City. He was the lead author of a recent study that reviewed the quality of bowel preparation for 12,787 patients who underwent colonoscopies at Columbia. The study, published in the June, 2011 issue of GIE: Gastrointestinal Endoscopy, found that the quality was either poor or fair for 24 percent, or about 3,000, of those patients. For those patients deemed to have performed inadequate prep, doctors had to repeat the colonoscopy within three years in 17 percent of the cases.
Current American Cancer Society guidelines for colorectal cancer screening through colonoscopy call for the procedure to be done once every 10 years beginning at age 50, unless you and your doctor opt for another procedure, such as sigmoidoscopy or barium enema. Sometimes circumstances call for a screening colonoscopy every five years.
The Columbia study also found a miss rate of 42 percent for all adenomas and 27 percent for advanced adenomas with patients that needed follow-up colonoscopies because of inadequate bowel prep. Doctors need to be able to spot abnormalities in the colon, such as precancerous polyps, in order to snip them off during the colonoscopy.
Your health care practitioner’s orders for prepping the colon usually call for drinking up to a gallon of liquid containing a cleansing medication, along with fasting for at least six hours and avoiding certain foods. For many patients, those can be hard orders to follow.
Next time you’re talking about an upcoming colonoscopy, be sure you know how to prep for it or face the possibility of repeating it.
Reviewed June 21, 2011
Edited by Alison Stanton