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Archive for February, 2016

The Top Five Excuses for Avoiding Colonoscopy

Your doctor has heard them all.

She has heard every excuse that someone can imagine for why they cannot have a colonoscopy. These excuses reflect the fears and apprehensions that patients have with medicine, in general, and medical examinations, in particular.

As with most fears, they boil down to one thing: a lack of information.

We reveal the five most common excuses that people give to delay colonoscopy and the reasons why each of these excuses can be dangerous.

I feel fine

While high blood pressure has earned the name the silent killer, the truth is that many diseases go undetected until it is too late. Colon cancer is a perfect example of one of those diseases. In early stage colon cancer, there are no symptoms. Patients may, in fact, feel just fine. As colon cancer advances, patients may experience a bit of blood in their stool that they made a mistake as a hemorrhoid. Perhaps the caliber of their stool begins to narrow, but they do not seem to notice. Indeed, very advanced colon cancer can cause a number of symptoms, but by that time treatment options are far more limited than they were when the cancer was in an early stage.

Feeling fine is not a good excuse for avoiding a colonoscopy.

Colon cancer does not run in my family

It is true that certain families do have much higher than normal rates of abnormal polyps and colon cancer. While colon cancer is very common in these families, it often occurs in people with no family history of colon cancer. According to the Centers for Disease Control and Prevention, colorectal cancer (colon cancer) is the third most common cancer in American men and women. If you have a large intestine, you are at risk for colon cancer.

While colon cancer may not run in your family, that is not a good excuse for avoiding a colonoscopy.

Colon cancer isn’t as dangerous as other cancers

People who voice this excuse tend to think that colon cancer is much more easily treated than breast cancer or ovarian cancer. They mention some statistic about prognosis and survival in colon cancer. Not only is colon cancer the third most common cancer among American men and women, it is the second leading cause of cancer-related deaths in the United States. Therefore, colon cancer is both common and deadly. One of the main reasons that treatment for colon cancer has improved over recent decades is because of the increased use of colonoscopy for colon cancer screening.

Misunderstanding the dangers of colon cancer is not a good excuse for avoiding a colonoscopy.

There is no way I can drink bowel prep

No one likes bowel prep. That is simply a fact. Who wants to drink half a gallon or more of the salty liquid? The truth, though, is that thousands of Americans drink bowel prep every day in preparation for colonoscopy examinations. Moreover, newer formulations of bowel prep are better than they were even 10 years ago. The amount of bowel prep/laxative one has to consume is smaller, the taste is not as bad, and it has become easier to swallow with newer formulations. If you are serious about guarding against a deadly cancer, you will be able to find a way.

Bowel prep is not a good excuse for avoiding colonoscopy.

I can’t handle it being…there

There are no two ways about it (sorry, bad pun), a colonoscopy involves a very sensitive place. Admittedly, a colonoscopy would be difficult, uncomfortable, and potentially painful without sedation. The good news is that nobody has a colonoscopy without sedation. Patients undergoing colonoscopy are placed under twilight anesthesia. Twilight anesthesia is sedation almost to the point of being unconscious. In fact, most people do not even remember the examination!

None of these reasons can excuse someone from having a colonoscopy. If you are uncomfortable, afraid, or do not think you need a colonoscopy, at least tell your doctor. With a frank discussion, good communication, and high quality information you may be able to overcome your apprehensions and have this life-saving examination.

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Just Call It EGD, Doctors Do

Perhaps you have seen incredibly long word written somewhere among the paperwork you received from your gastroenterologist or primary care physician. It has enough syllables to make your eyes spin. In fact, the word is so long that it is almost frightening.

Esophagogastroduodenoscopy

It has the same number of letters as the English alphabet. Scary, but it doesn’t have to be.

While knowing the word esophagogastroduodenoscopy is helpful for doing your own medical research online or impressing your friends after you have practiced saying it a few times (ĕ – sof′ă – gō – gas′trō – dū′ō – den – os′kŏ – pē), practically no one says the whole term. Patients usually call the exam an upper GI, but doctors use the acronym EGD. You may see EGD in patient notes, on medical charts, and even in physicians’ orders. EGD means esophagogastroduodenoscopy.

An EGD is essentially a colonoscopy for the esophagus, stomach, and first part of the small intestine called the duodenum. An EGD is a diagnostic endoscopic procedure that allows your gastroenterologist to look for any abnormalities in this part of your digestive system. An EGD may be performed under urgent circumstances, for example, after someone accidentally swallowed a caustic substance or has bleeding in the stomach. More commonly, however, and EGD is a planned examination and therapeutic intervention.

Your gastroenterologist is able to do any of the following procedures during an EGD:

  • Treat a bleeding ulcer or other source of bleeding in the upper GI tract
  • Remove foreign bodies
  • Place the feeding tube
  • Remove polyps
  • Dilate certain areas that are constricted
  • Ablate (burn off) suspicious areas

While the term esophagogastroduodenoscopy may be unwieldy, the actual examination is straightforward. Most patients only require light sedation and analgesia. While it is true patients must avoid solid foods for at least eight hours before an EGD, patients can usually consume clear liquids up to two hours before the procedure. An EGD is an outpatient procedure, which means most patients do not require a hospital stay and can be driven home by a friend or loved one the same day.

As with many things in medicine, the medical term is far scarier than the actual intervention. Feel free to call your esophagogastroduodenoscopy an EGD. Your doctors already do.

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Four Things You Didn’t Know About Bowel Prep

It is not something anyone likes to talk about, but for most people it is something that deserves discussion at least once every several years: bowel prep. Bowel prep is something that precedes a colonoscopy. In most cases, a person about to have a colonoscopy must consume a large quantity of liquid that helps clear out the colon of any digested material. Bowel prep is never fun, but it is also something that does not need to be dreaded or avoided.

Here are five things you may not have known about bowel prep.

1. If you do not do it right the first time, you may need to do it again.

Your gastroenterologist needs to be able to see every surface of your large intestine. Your large intestine or colon is a 5 foot long tube that is normally occupied by digested material waiting to be expelled. Bowel prep is used to clear out this tube so that your gastroenterologist can get a clear picture of the health of your colon. If she cannot see certain areas that could be hiding a polyp or other abnormality, there is very little she can do during the colonoscopy. If there is a little something in the way, she may be able to apply sterile water to clear it; however, in most cases an incomplete bowel prep will mean an incomplete colonoscopy. That means you will have to reschedule the colonoscopy and do bowel prep all over again.

2. Some drugs should continue, some drugs should stop

This is always the big question before any procedure: what should I do about my medications? The golden rule is to follow all of the instructions you received from your gastroenterologist. They take priority over everything you read here. That said, you will most likely need to stop taking any iron supplements at least five days before your colonoscopy. Iron supplements make feces very black and sticky, which the bowel prep may not be able to clear from your large intestine. Certain diabetes medications may need to be held until after the examination. If you must take anticoagulants (a.k.a. blood thinners), you may or may not continue taking these drugs during bowel prep and during colonoscopy. Make sure to discuss anti-coagulation with your gastroenterologist before the exam.

3. Bowel prep may be more than just that bowel prep solution

Even under the best of circumstances, you will to consume between 2 and 4 liters of bowel prep solution the evening before your colonoscopy. However, bowel prep starts days and even a week before colonoscopy. On the day before your colonoscopy, you will probably be instructed to consume clear liquids. These are less likely to get in the way of your gastroenterologist’s view of your large intestine. Some G.I. doctors also recommend a “low-residue diet” for 2 to 5 days before the examination. A low-residue diet is one that is high in fiber and includes fruits, vegetables, and whole grains.

4. Bowel prep can save your life

While it is true that bowel prep itself is not going to cure cancer, a successful bowel prep can be the difference between detecting and missing colon cancer. If you successfully complete your bowel prep, your gastroenterologist will be able to see everything she needs to see, analyzing and addressing every polyp and abnormality. Having a colonoscopy substantially reduces your risk of having advanced form of colon cancer. Moreover, if the procedure is performed when recommended, colonoscopy saves lives. So, while colonoscopy is the real hero, proper bowel prep is an indispensable sidekick.

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CT Colonoscopy Deemed “Not Acceptable” For Some Forms of Colon Cancer

Colonoscopy is a lifesaver, but it is an examination that some people dislike doing. As such, the research community is looking for alternatives to traditional colonoscopy. One of these alternatives is to use computed tomography (CT) to examine the large intestine instead of using a colonoscope. While patient still have to undergo bowel prep, they simply need to spend some time in a CT scanner without sedation or additional instruments. While CT colonoscopy may be useful in the future, a recent study suggests that it is not yet ready to replace traditional colonoscopy.

Japanese researchers followed 47 patients with definitive colorectal cancer, confirmed by a pathologist and subjected these volunteers to both a traditional colonoscopy and a CT colonoscopy. 1 The researchers found that laterally spreading tumors went undetected by CT colonoscopy 40% of time. A subset of laterally spreading tumors, called non-granular tumors, were missed in nearly 70% of cases.

This means that if CT colonoscopy were used as a screening tool for the general population, the technology would miss 4 out of 10 people with laterally spreading colon cancer. Only three people out of 10 with non-granular, laterally spreading tumors would have their cancer properly detected by CT colonoscopy.

Not surprisingly, the authors of this study concluded “the detection rate of lateral spreading tumors by CT colonoscopy, particularly the non-granular type, was not acceptable.”

While patients, researchers, and clinicians are eagerly awaiting alternatives to traditional colonoscopy, the technology has to be safe and effective, not just more convenient. Until improvements can be made or a better alternative can be found, CT colonoscopy apparently cannot be used to replace traditional colonoscopy as a screening tool.

Reference

1. Togashi K, Utano K, Kijima S, et al. Laterally spreading tumors: limitations of computed tomography colonography. World J Gastroenterol. Dec 14 2014;20(46):17552-17557. doi:10.3748/wjg.v20.i46.17552

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