Demystifying a procedure that's the butt of jokes


What you can expect from a colonoscopy, a potentially life-saving operation that can decrease your individual risk of dying from colorectal cancer by roughly 80 percent?

A colonoscopy is a medical test by which an instrument is inserted into the person's rectum and advanced through the large bowel in to check for cancers and precancers. The examination is frequently the butt end of jokes on morning talk shows and subject to ridicule. Still, it is by far the best procedure that effectively screens for colorectal cancers.

Individuals are often kept from undergoing the crucial exam because of misconceptions, insecurities, and challenges such as:

  • I have to drink a gallon of fluid in four hours.
  • The procedure is extremely painful.
  • There are potential complications.
  • The experience may seem embarrassing.
  • How will I afford the procedure?

Generally, the bowel preparation is considered the hardest part of the entire process. This takes place the day before and consists of either a number of pills or a liquid to cleanse the bowel. This is enormously important because only a good bowel preparation allows the examining doctor to see all the folds and not only detect larger polyps (mushroom like growths) but also tiny flat spots, that we increasingly recognize as potentially dangerous. In order to avoid dehydration during the preparation phase, it is imperative that patients consume liquids. They can choose from Jell-O, soups, soda, tea, coffee or Gatorade.

Patients are allowed to drink up to three hours prior to the scheduled test.

The day of the procedure, patients arrive at the outpatient center, where the test is performed. Patients need a "designated driver" because we will not start the test unless there is a person available afterwards who can accompany our patient and drive them home.

Informed consent is obtained when physicians and patients discuss and agree upon the procedure. While complications may happen, they are extremely rare and occur at a rate of less than one in a thousand. Every responsible doctor is obligated to counsel every patient on the principal risks of allergic reactions to medications, bleeding, or an inadvertent perforation in the colon during the procedure. It is impossible to promise the absence of complications, but what experienced gastroenterologists can provide is assistance in the early detection and repair of an adverse reaction.

An IV line is placed in the forearm. Expert nurses assess the patients. An update of the patients' medical history is obtained in conjunction with the doctors.

Then, the patients are taken into the procedural area. While in the past minimal sedation was used, we now tailor and administer the right dosages of medications to guarantee that every patient is as comfortable as possible, while he or she is closely monitored. Typically, we call the level of sedation, or sleepiness, "conscious sedation", meaning the person is still able to breathe on his/her own but is very sleepy. Some of our patients have special needs and require the help of an anesthesiologist to achieve deeper levels of sleepiness. The medicine makes one very forgetful and many of our patients do not remember anything following the test.

The actual test lasts only 20 minutes or less, unless we encounter a difficult polyp. Our tube is inserted and the doctor and nurses observe the colon on a flat screen. We respect the privacy of all our patients.

If a polyp is found, we can carefully remove it by using special instruments with a lasso technique applying cautery or snip it out with a forceps or destroy it with argon gas. Larger polyps can be tattooed with ink and marked for future surgery or repeat examinations. In roughly 15 percent of females and 25 percent of males we do find such polyps. The removal is not painful, since there are no nerves present in the colon that transmit pain sensation.

Afterwards, our patients recover in a special area. It is important to pass all the gas that we inserted prior in order to visualize the colon. We challenge with a light diet to make sure it is safe for the patient to go home.

If a polyp is removed, a pathologist, a doctor trained in looking at surgical specimens, will interpret the findings under a microscope and file a report. Typically, if there is no strong family history of cancer and no dangerous polyps were seen, a repeat examination in 10 years is advisable, while patients with polyps or having family members affected by polyps or cancer are asked to come back earlier.

Both Oregon and Washington have passed legislation that mandate all insurance companies must provide this potentially life-saving test as a mandatory benefit for their clients.

Dr. Harald Schoeppner is a gastroenterologist at Providence St. Mary Medical Center.


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