Colonoscopy in America and Western society
is one of the most well recognized screening methods for colorectal cancer. What it allows
us to do is find precursor lesions or polyps. There is a well recognized sequence of events
from finding a garden variety polyp in the colon and having over time, that polyp turning
into colorectal cancer. That usually takes between 5-10 years. That’s why we generally
have screening intervals of 3-5 or 5-10 years when we find a polyp. We put people into categories: high risk,
and low risk. Most people are somewhere in between.
High risk is people with family history of colon cancer in someone who’s young. We define
young as under age 60. We define low risk as people with no family
history and are otherwise very healthy. Maybe they have a little obesity or high blood pressure
are the only health problems they have. So, for an average risk individual who’s in
sort of that ‘low risk’ category, we recommend for caucasians to begin screening at age 50.
And African-Americans at age 40. The African American data is relatively new in the last
2-3 years, but seems to have a lot of merit to it in the medical journals. People do think it’s painful. I tell my patients
it’s not painful, but it’s not comfortable either. I tell them we use a combination of medicines
that, one of which is a pain medication. I tell them again it’s not a painful procedure
but can be uncomfortable. We use that in conjuction with something called Valium. We don’t use
Valium per se, but we use one of its cousins called Verced.
The two meds together work like a third medication. They have a synergistic effect. That’s how
I address the sedation. The bowel prep is something we’re always trying
to tweak and make better. There are all kinds of bowel preps out there,
there are Gatorade preps, there are other volume preps. We’ve tried cutting the volume
in half and using pills. Everybody is trying to come out with something
new. The newest kind is called “split dose prepping.”
Anyone who does scoping should know about this.
You do about 2/3 the night before and the last third the day of the procedure. It cleans
the colon out much better; it’s been proven in many studies. From a complication standpoint, any procedure
that we do endoscopically has complications. Most people come to find out when they talk
to me or one of my partners that it’s related to the sedation.
Too much sedation is a bad thing just like too little can be bad from a patient standpoint.
From the procedural standpoint, complications associated with colonoscopy are pretty uncommon.
I quote people about one in 2500 or 1 in 3000 will experience a complication like a hole
in the colon or some bleeding after taking off a polyp, those sorts of things. My answer to anyone who is older than age
50 and hasn’t had one is – they should. Colonoscopy is the one test in the GI world
that makes a difference every day. There are lots of fancy procedures; some I do, some
my partners do. But colonoscopy is a gastroenterologist’s bread and butter.
It allows us to screen people and treat people for polyps and cut down on that risk for colorectal
cancer. The cure rate when you find a polyp is excellent.
It’s 100% if you find it early enough. If you find a precursor lesion or a polyp
with some pre-cancerous cells in it and you take that out then the survival rate is excellent.
It’s the folks who don’t undergo the screening when they’re younger and maybe when they have
a change in bowel habits or have some blood in the stool and they ignore that… unfortunately
they often present later with disease that’s in a lot of places.