Colonoscopy Preparation - A Better Option

Common Sense Points To A Kinder And Better Method

Colon
 

Take Home:

You have better, more pleasant things to do than pouring your innards down the drain while ruling the land of Bath Room from your porcelain throne. Research shows that a simple warm water flush is better healthcare, better for the doctor, and better for the patient in preparing for a colonoscopy. Thousands of lives could be saved from an unpleasant and untimely death by using this more pleasant "prep" method.
 

Why Is This Important?

At a recent class reunion one of my best friends from high school and college told me that his dad was just finishing a 6 month course of chemotherapy after having 21 centimeters of his colon removed for colon cancer. His dad was looking forward to not having to be so sick from the chemo that he couldn't do anything much but lie around on the couch for 6 months. Like many, he hadn't done the recommended screening colonoscopies to find and remove cancer very early before it advanced to the point of causing symptoms and requiring drastic treatment. And even with all this surgery and chemotherapy, his "good" odds are 75% that they got all the cancer.
 
Colon cancer (including rectum cancer) is one of the most common kinds of cancer and one of the deadliest. In 2010 in the United States over 142,000 cases of colon (and rectum) cancer were diagnosed, and over 51,000 people died from this cancer. The good news is that it can be found early and removed most of the time before becoming much more serious. But many choose not to do these potentially life-saving procedures because they are so unpleasant. To be more precise, those who have done them consistently say the worst part is the "prep" - or preparation - of cleaning the colon out so the doctor can "see" with his scope. If we could come up with a better "prep" that wasn't so onerous, many more people would do the procedure and many thousands of lives would be saved.

Typical Treatment

Methods of preparation for colonscopy that are commonly used today are various forms of putting something in your mouth that makes everything between your mouth and your anus flush out your anus - which is typically the last 1-3 days worth of food. Ideally, this leaves a fairly clean colon so that the doctor performing the colonoscopy can see and deal with spots or bumps ("polyps") that might be cancerous or pre-cancerous. Unfortunately, the things you must put in your mouth are often unpleasant, and you must dedicate the block of time until the colonoscopy to your kingdom of Bath Room so that you can make profuse donations of many meals in various stages of digestion to the porcelain receptacle designed for such donations. Too many find the substances unpleasant enough that they don't take all of the prescribed amount, resulting in a colon that is not clean enough to see everything that might be a problem. Most find that the actual colonoscopy wasn't so bad because they were given medicine to make them sleep. But they often can't bring themselves to do the "prep" process.

Comparison Of Methods:

A study published in 2006 in The American Journal of Gastroenterology compared a simple warm water flush of the colon on the day of the procedure with two of the standard top-to-bottom flush methods.
 
1. One common medicine used to clean out the GI tract is aqeous sodium phosophate, or ASP. It is essentially a Fleet enema (same active ingredients) from the top down. It can cause significant kidney problems in some people.
 
2. Another common medicine is polyethylene glycol, or PEG-ES. It, and its large pool of cousins, are used in a very wide variety of industrial, commercial, and medical applications. It is rather unpleasant tasting and is best known for having to literally drink a gallon of this liquid.
 
3. The third method used is called hydrotherapy in this study. It is very similar to a "colonic" in the world of alternative medicine and is identified in this study as HYDRO. They did a simple but professional warm water flush of the colon on the day of the procedure. The patients did not have to take in nasty tasting things, consume large quantities of liquids, or donate their prior evening to the land of Bath Room. They also didn't have to fast or otherwise alter their diet.

Findings:

Doctors rating 
 
Patient ratings 
 
Patients who would do again 

Summary

1. The warm water flush did a better job of getting the colon clean.  The doctor  could see better, potentially seeing small cancers that might be missed if the colon were not as clean.  It makes for higher quality healthcare.
2. Patients liked it much better, finding it easier, more comfortable, and more convenient.
3. Patients were dramatically more satisfied with the warm water flush.

Take Home

A truly patient-centered process of colonoscopy would provide common-sense services such as warm water flushes on the day of the procedure.  With much less onerous "preps" many more will be willing to do colonoscopies and thousands of people each year will not die unnecessarily.  Wouldn't you like to have Mom and Dad around to be grandparents for another 10 or 20 years?  I would.
 
The Healthcare Advocate Institute is not only here to tell you about better options for your healthcare, but also to help you be able to access those better options.  We will be creating a network of healthcare providers who are offering better options to people.  If you are a healthcare provider and would like to be part of our network of better treatment providers, let us know.  Or if you see healthcare providers that truly seek to provide the best patient-centered care possible, tell them about us and suggest they join our network. 
 

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REFERENCES:

Colon cancer statistics: http://www.cancer.gov/cancertopics/types/colon-and-rectal
The American Journal of Gastroenterology 101, S494-S540 (September 2006) | doi:10.1111/j.1572-0241.2006.00001_10.x
 
Last updated 4/26/11.