Colonoscopy keeps getting better. The following is a discussion of newer techniques and aspects of colonoscopy, especially as it is done to prevent colon cancer.

            Just how effective is colonoscopy for cancer prevention? A new study in the January 2011 issue of the Annals in Internal Medicine shows that a properly administered screening program can decrease colon cancer risks upwards of 80%. To those of us who work in this field, this is no surprise. If people follow accepted screening protocols, colon cancer seems to almost never occur. Removal of the pre-malignant polyps that cause nearly all colon cancers is safe, painless, and prevents the cancer. In half of colonoscopies, polyps are found and removed. In the US population at large, without screening, colon cancer occurs in 5-6% of people. There are usually no symptoms from the developing cancer until it has grown to a point where major surgery is required to treat it.  Cure at that time is often not possible. Although there have been improvements in chemotherapy for advanced colon cancer, these treatments rarely cure the cancer. Prevention is dramatically more effective. Current recommendations are that colonoscopy be performed initially at age 50, and once every 10 years after that. If polyps are found, a five-year screening interval is suggested. If a family member has had colon cancer, protocols indicate screening should begin at age 40 and every five years thereafter.

            While the idea of colonoscopy is admittedly a little daunting, the actual process of getting it done is quite straightforward and has improved in the past few years. In the past, we inflated the colon with air in order to advance the colonoscope through the colon. Reports in the medical literature starting in 2009 indicate that inflating the colon with water instead of air promotes a more comfortable experience. This is called water-assisted colonoscopy. From mid 2009 to the present, all colonoscopies done by me have utilized the water-assisted technique. In the medical literature and in my experience, many patients do very well without any sedation through the use of water-assisted colonoscopy. However, most patients still prefer the gentle sleep we induce with sedative medications. We decide how to proceed in a pre-colonoscopy discussion with each patient.

            A commonly heard observation over the years is that the worst part of the colonoscopy is the prep. A patient has to take laxatives the day prior to the colonoscopy in order clean the colon. All aspects of the preparation have improved. Very few patients find the prep unpleasant, and most comment how easy it is.

            The flavor of our prep is a mild and quite pleasant citrus flavor. This represents a dramatic improvement over the past preps, which, at best, tasted like salty dishwater. Some were even worse. Most people report our prep solution tastes like a fruit punch. The safety of this newer prep is very good, with no reported complications in over several thousand procedures. We are using vitamin C as part of the prep since it has laxative properties and enhances the flavor.

            The volume needed for the prep has also improved. The standard preps, still used in most of the country, require 4 liters of solution to be consumed. This is a little over a gallon. That is a lot to drink, especially if the flavor is not so good. Our recipe is weight based, people at 150 pounds and under drink a little over 2 liters. For those over 150 pounds, we add another 2 cups. This has cut the volume by just about half. As a person has over half a day to consume the prep, most people feel this quantity is easy to consume.

            Most colon preps require a person to consume only clear liquids for the entire day prior to the colonoscopy. To me, this feels a little like starvation. Although high fiber meals could be a problem, we suggest our patients eat a low fiber meal for both breakfast and lunch the day prior to the colonoscopy. 

            Preventive medicine, though appealing, can be expensive. Health care reform has addressed the expense problem with prevention. As of September 2010, screening colonoscopy (and other selected procedures) must be covered with no out of pocket expense and no deductible in all newly written insurance policies. Even in older policies,  many insurers have similarly covered screening colonoscopy. Apparently, the insurance industry is becoming aware that ridding our population of advanced colon cancer provides considerable savings that offsets the cost of the colonoscopy itself. Medicare has covered colonoscopy for almost ten years. Avoiding surgery and chemotherapy saves the healthcare system substantial resources that can better be used elsewhere.

            The staff at Yampa Valley Medical Center are passionate and experienced in the use of screening colonoscopy for prevention of colon cancers. The facility is top notch. No effort is spared in providing a safe and effective colonoscopy and a pleasant experience. In fact, many cancers have been prevented and surgery avoided. As a physician, this is extraordinarily rewarding.

            My mother had colon cancer in the era prior to routine screening. She was cured with major surgery. Her mother died from colon cancer. I don’t want to get colon cancer. I don’t want my patients or the populations for whom I feel responsible to get colon cancer. I hope and expect that we can make colon cancer a rare occurrence that almost never happens. With a prudent and expert approach to colon cancer screening and prevention, we can achieve this.                      -Mark C. McCaulley, M.D.