This was the voicemail I recently received from one of my patients regarding his preparation for an upcoming colonoscopy exam. As you can see, he was a bit upset about our new preparation (prep) instructions. We have made some changes and it's all about accuracy. I thought perhaps I should explain.
Before we proceed, let's briefly review a few facts about colon cancer:
2. Now the good news. Colon cancer is unique in that it can be prevented. This is because almost every colon cancer begins many years before as a small benign (noncancerous) growth called a polyp. It may take ten years for that small polyp to grow larger and turn malignant (cancer). Unfortunately, there are no symptoms of a polyp. But if an individual makes the effort to find and remove that polyp before it turns malignant, the cancer they were destined to develop is prevented. This is unlike most other common cancers (breast, prostate, lung, kidney, brain, pancreas. etc.) which cannot be prevented. These cancers can't be diagnosed until after cancer cells actually develop - often too late for a cure. Colon cancer is different. We can find it before you get it.
3. For over 30 years, we have had the technology to prevent colon cancer by finding and removing any polyps that are present. This technology - know as screening colonoscopy - allows us to find your future colon cancer even before you get it. It's a miracle that most people don't understand. I think that is because this process is often referred to as "Colon Cancer Screening." This terminology is really not accurate. A more appropriate terminology would be "Colon Cancer Prevention through Colon Polyp Screening." Sadly, many individuals still are not screened. Researchers with the U.S. Centers for Disease Control and Prevention reported in January 2012 that over 40% of Americans still do not comply with screening recommendations.
By finding unsuspected polyps and removing them by a procedure called polypectomy, screening colonoscopy has been shown to greatly reduce your personal risk of colon cancer. By the age of 50, every adult should undergo periodic screening. Colonoscopy is an important test and it is crucial that it be performed accurately.
Ok, now we know that this common and deadly cancer is highly preventable by taking advantage of screening colonoscopy. This is an important exam and you want to do it right. It is crucial that the exam be as accurate as possible. No exam in medicine is 100% perfect including colonoscopy. There will always be a small number of polyps that are missed. It is important to make that number as small as possible. You want your test to be accurate.
The accuracy of colonoscopy exam depends on three factors:
2. In terms of accuracy, a less important factor is the equipment used and the environment in which the procedure is performed. Factors such as the type of instruments used, the type of anesthetic given, the quality of the nursing staff, and cleanliness of the facility are all important for patient safety and comfort, but do not greatly affect accuracy.
3. Probably the most important factor affecting accuracy is what you do at home to prepare for the examination. This is referred to as your "prep." The quality of the laxative preparation is the one factor which you have the most control over. You can have the best and most experienced doctor in the world using the latest equipment in a wonderful modern facility, but if your colon is not well cleaned out, the accuracy of the test is greatly diminished.
Why we changed our prep
Why is this? As you can see in this illustration, the small intestine drains its contents directly into the cecum and right colon. This process goes on 24 hours a day whether you eat or not. Our previous prep regimen did a good job of cleaning out the colon the night before the exam. But while patients slept overnight, the digestive juices, liver bile, and pancreatic fluids drained out of the small intestine and into the cecum often coating the lining with a yellow viscous liver bile. Occasionally, these secretions would impair the doctor's view of the cecum.
Fixing the problem
What this means to our patients
This means that if you want an early morning appointment, you have to awaken in the middle of the night to finish your prep. If your test is planned for 8 am, you have to consume the second part of the prep between 3 am and 4 am. Not very convenient and not much fun, but very important.
Let's do it right