Have a Nice Colonoscopy: New Test Eliminates Probing, Laxative

Steve Williams

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This is not really new news but is still an important read

I highlighted at the bottom the important fact to remember

By Rachael Rettner, MyHealthNewsDaily Staff Writer | LiveScience.com


Colonoscopies could be made a bit more comfortable for people if they involved lying in a CT scanner, rather than being probed with an endoscope, and at the same time didn't require drinking upward of a gallon of laxative fluid beforehand — current requirements that most consider unpleasant.
A new type of "virtual colonoscopy" that uses CT scans to construct images of the colon, as well as to virtually "clean" the organ, was just as effective as a standard colonoscopy in finding colon polyps 1 centimeter or larger in size, a new study finds. Most polyps, or growths on the lining of the colon, are benign, but some can turn cancerous.
"The subtraction of the laxative can only make what's already an attractive test even more attractive," said Dr. Durado Brooks, director of prostate and colorectal cancer at the American Cancer Society, who was not involved with the study.
The discomfort of colonoscopies may deter some people from getting screened, said study researcher Dr. Michael Zalis, an associate professor of radiology at Massachusetts General Hospital.
If this laxative-free, CT scan type of virtual colonoscopy becomes an option for colon cancer screening, Zalis said, it could increase the number of people who get screened, and thus reduce the number of deaths from the disease.
The laxative-free method was not as effective as a standard colonoscopy in finding polyps smaller than 1 centimeter, but polyps of this size are less likely to cause cancer, according to the National Institutes of Health. The new findings must be confirmed by larger studies before the test is put into practice, Zalis said.
The study is will be published Tuesday (May 15) in the journal Annals of Internal Medicine.
No laxative required
Each year, there are about 120,000 new cases of colon cancer in the United States, and 50,000 people die from the disease,Zalis said.
Several methods are available to screen for colon cancer, including blood and fecal tests. But the "gold standard" is the colonoscopy, and the type most commonly performed is the optical colonoscopy, which uses a fiber optic tube with a light and camera to examine the internal surface of the colon. Another method, computed tomographic colonography (CTC), uses images produced by CT scans to indirectly view the colon. Both methods require patients to drink a laxative the day before their procedure.
More than 90 percent of colon cancer screening is done with colonoscopies or the blood tests, Brooks said.
In the new study, 604 people ages 50 to 80 who were eligible for a colonoscopy received the new test — a laxative-free CTC. Participants were required to eat a low-fiber diet for two days before the procedure, and to ingest small doses of a contrast agent that labeled their stool so that it was distinct from the colon on an X-ray. About five weeks later, the same patients were given an optical colonoscopy.
The laxative-free CTC correctly identified 91 percent of people with polyps 1 centimeter (10 millimeters) or larger. The results for the optical colonoscopy test were similar; it identified 95 percent of people with polyps of this size.
However, the colonoscopy was better at finding smaller polyps: it correctly identified 76 percent of people with polyps 0.6 centimeters or larger, while laxative-free CTC identified 59 percent of people with polyps of this size.
Three cases of colon cancer were diagnosed in the study. These cases were detected by both screening methods.
Participants said the laxative-free method was more comfortable and easier to prepare for than the colonoscopy. Sixty-two percent said the laxative-free method was their preferred method of screening.
Not a 'game changer'?
While laxative-free screening might increase the number of people who get colon cancer screening, "I don’t think it will be the big game changer that [the authors] suggest," said Dr. John Monson, chief of the division of colorectal surgery at the University of Rochester Medical Center, in New York, who was not involved in the study.
There are many reasons people do not get screened for colon cancer besides the requirement of a laxative, Monson said. For instance, some find other aspects of the test not agreeable, and others may be frightened to know the results, he said.
All virtual colonoscopies have a disadvantage in that, if polyps are found during the test, a follow-up colonoscopy is needed to remove them, Monson said. In addition, while polyps larger than 10 millimeters confer the greatest risk of colon cancer, most doctors do not feel comfortable leaving behind polyps that are 0.6 centimeters in size, Monson said.
CTC is currently considered an accepted method of screening by the American Cancer Society, but not by the U.S. Preventative Services Task Force.
The ACS recommends that people who get virtual colonoscopies be re-screened in five years; those who get optical colonoscopies are recommended to wait 10 years between tests.
Zalis said laxative-free CTC might first be offered to people who have only a moderate risk of colon cancer (those 50 and older without a family history of the disease, or other risk factors, such as inflammatory bowel disease). Some people may also be unable to have a colonoscopy, for instance, if they cannot be sedated for a medical reason.
While CTC uses X-rays, the dose is much lower than that required for a CT scan used to diagnose disease, Zalis said. A study published in 2005 published in the journal Gastroenterology concluded the cancer risks associated with exposure to radiation from CTC are small.
Pass it on: Laxative-free colonoscopies may be an option for colon cancer screening in the future.
 

amirm

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Having had a colonoscopy and finding the prep process extreme unpleasant, I can't wait for this option to become available.
 

Steve Williams

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Having had a colonoscopy and finding the prep process extreme unpleasant, I can't wait for this option to become available.

my hospital has done this option for well over 5 years but again guys remember that if a polyp is found you will still need a biopsy to excise it and hence a standard colonoscopy
 

ack

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As stated in the article, the resolution is not fine enough yet, so 1cm doesn't cut it yet - this has been the main problem with this approach for decades. When doctors, as stated, don't feel comfortable leaving in polyps as small 0.6cm - potentially undetectable by scans - it is obvious why this approach isn't really a viable option.
 

ack

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It's not bad, nothing like giving birth (as you know!); we should all be thankful this is a disease that can be prevented.
 

Steve Williams

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It's not bad, nothing like giving birth (as you know!); we should all be thankful this is a disease that can be prevented.

I agree. I went to IHOP for pancakes after mine. It's almost time for my second one (10 yrs)
 

ack

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Manhood ends around 50 if not earlier :( Wait till they feel your prostate :eek: and that one is LIVE
 

jazdoc

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Perhaps I can offer some perspective as a practicing radiologist...

Colon carcinoma is the 2nd leading cause of cancer death in the country yet has become a largely preventable disease. Unlike some other screening tests, the goal is to prevent colon carcinomas or at the very least detect the disease at an early stage, where the chance of successful treatment is much greater. (By comparison, the goal of mammography is to detect low stage, potentially curable carcinoma.)

Yes the prep for a colonoscopy is unpleasant. For those who have yet to have the test, it requires drinking an uncomfortable large volume of unpleasant tasting liquid which cleanses the colon. This is done in conjunction with a 12 hour fast. So you are uncomfortable for 6-12 hours. You are completely sedated for the exam and will almost certainly have no memory of the test (Versed is a wonderful thing). Seems well worth it to me. Serious complications are rare.

Standard CT colongraphy (CTC) has a prep similar, but less vigorous than colonoscopy. Prior to obtaining images, a tube is placed in the rectum to insuflate air/CO2 in order to distended the colon. Most patients prefer CTC rather than colonoscopy. While the detection rates for larger (> 1cm) lesions are comparable, CTC is far less accurate in detecting small (<1cm) polyps when compared to colonoscopy. And as Steve has pointed out, if a lesion is found a CTC, a standard colonoscopy is mandated. It should be noted that insurance coverage for CTC is variable. IMO, CTC should be seen as a complimentary test to colonoscopy. I suspect that in the future, it will be used between standard 10 year colonoscopies

It is important to remember that these tests are screening exams. A screening exam can be defined as a test to detect disease in an asymptomatic population at increased risk for that disease. For colon carcinoma, increased risk is defined primarily by family history and age. If you have certain rare conditions (i.e. familial polyposis syndromes) or a personal history of colon polyp/carcinoma, colonoscopy is considered diagnostic and CTC has a limited role.

I would urge WBF members to review the indications for colon screening which can be found here: http://www.cancer.org/Cancer/ColonandRectumCancer/DetailedGuide/colorectal-cancer-detection. Talk with your primary care physician and gastroenterologist. When you see your GI doc, ask them how long, on average, they spend during the procedure (polyp detection corresponds to time spent looking), their cancer detection and complication rates.
 

Steve Williams

Site Founder, Site Owner, Administrator
Perhaps I can offer some perspective as a practicing radiologist...

Colon carcinoma is the 2nd leading cause of cancer death in the country yet has become a largely preventable disease. Unlike some other screening tests, the goal is to prevent colon carcinomas or at the very least detect the disease at an early stage, where the chance of successful treatment is much greater. (By comparison, the goal of mammography is to detect low stage, potentially curable carcinoma.)

Yes the prep for a colonoscopy is unpleasant. For those who have yet to have the test, it requires drinking an uncomfortable large volume of unpleasant tasting liquid which cleanses the colon. This is done in conjunction with a 12 hour fast. So you are uncomfortable for 6-12 hours. You are completely sedated for the exam and will almost certainly have no memory of the test (Versed is a wonderful thing). Seems well worth it to me. Serious complications are rare.

Standard CT colongraphy (CTC) has a prep similar, but less vigorous than colonoscopy. Prior to obtaining images, a tube is placed in the rectum to insuflate air/CO2 in order to distended the colon. Most patients prefer CTC rather than colonoscopy. While the detection rates for larger (> 1cm) lesions are comparable, CTC is far less accurate in detecting small (<1cm) polyps when compared to colonoscopy. And as Steve has pointed out, if a lesion is found a CTC, a standard colonoscopy is mandated. It should be noted that insurance coverage for CTC is variable. IMO, CTC should be seen as a complimentary test to colonoscopy. I suspect that in the future, it will be used between standard 10 year colonoscopies

It is important to remember that these tests are screening exams. A screening exam can be defined as a test to detect disease in an asymptomatic population at increased risk for that disease. For colon carcinoma, increased risk is defined primarily by family history and age. If you have certain rare conditions (i.e. familial polyposis syndromes) or a personal history of colon polyp/carcinoma, colonoscopy is considered diagnostic and CTC has a limited role.

I would urge WBF members to review the indications for colon screening which can be found here: http://www.cancer.org/Cancer/ColonandRectumCancer/DetailedGuide/colorectal-cancer-detection. Talk with your primary care physician and gastroenterologist. When you see your GI doc, ask them how long, on average, they spend during the procedure (polyp detection corresponds to time spent looking), their cancer detection and complication rates.

Agreed Mark however the prep methods differ. Yes there are preps like a huge volume of "golitely" or the 3 oz of prep I drank which tasted like the Dead Sea but as they say, don't wander too far from a toilet. This is the standard prep used at our hospital. Only 3 oz but get ready to "rev your engines"
Versed is a miracle drug. I have now had it 3 times and complete amnesia to the procedure
 

Bruce B

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Steve Williams;110029Versed is a miracle drug. I have now had it 3 times and complete amnesia to the procedure[/QUOTE said:
While Versed (Midazolam) is the common protocol, I also give my patients a low dose of Fentanyl to make them feel "comfortable"!
 

jazdoc

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Agreed Mark however the prep methods differ. Yes there are preps like a huge volume of "golitely"

Golitely is known affectionately as 'the green grenade' :D

A couple of points I neglected to mention in my previous post...CTC requires meticulous attention to detail and exquisite technique to produce high quality images. Certainly not just 'point and shoot'. Also, image interpretation is definitely an acquired art with a learning curve...not something that can be mastered at a weekend destination course.
 

cjfrbw

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One of my patients is in a band, and told me about their bass player.

He said his friend had a colonoscopy and they found a couple of small polyps that looked "suspicious." They told him the safest thing to do would be to have them surgically removed. He complied.

Apparently, there was an undiscovered "leak" after the procedure. His friend became septic, and his kidneys failed, his blood pressure dropped and he had a stroke. He recovered, but has some severe short term memory loss and global brain syndrome of some kind.

When they did a more complete biopsy of what they removed, it was benign and probably never would have caused him any problem.

Also, it is impossible for me to imagine that those expensive fiber optic instruments could ever be properly sterilized without ruining them. Hepatitis maybe?

At any rate, apparently not a risk free endeavor.
 

Steve Williams

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Unfortunately bowel perforation is indeed a risk to the procedure and any good gastroenterologist when he discusses "informed consent" with his patient will (should) always discuss perforation as a risk.

As for sterilization of the fiber optic scope there is no issue with proper sterilization
 

cjfrbw

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"The next time your doctor suggests you have another colonoscopy done, first take the time to really weigh up the risks versus the possible benefits. Did you know it is impossible to sterilize a colonoscope? Don’t be surprised if even your doctor doesn’t know this. I’ve provided a download link for this full report (below) that you can print out and take in to your doctor – with all the research (from peer-reviewed medical publications) outlined.

So, let’s get started. First of all, this report is going to outline only the most prevalent risks that are present with every colonoscopy. I’m not going to get into rare risks here, like intestinal perforation, just those that may occur through routine procedures.

Regarding possible benefits, the first question you should ask yourself and your doctor is: Will the results of this colonoscopy change the course of treatment? Certainly, there are serious occasions where the best course of action is to have the colonoscopy. But, if your doctor is primarily recommending a colonoscopy as an information-gathering procedure, or as liability protection, then it’s not going to benefit you too much. It may, however, cause a lot of damage and that’s what this report is going to help you assess.

Here’s how a colonoscopy procedure works: First, you have to self-administer a ‘bowel preparation’ procedure. This consists of substances that cause you to completely clear out your bowel and leave the walls of your colon squeaky clean so the fiber optic camera can get a good picture of what’s happening with your mucosal lining and intestinal wall. Understandably, causing a complete clear out of everything from your bowels (usually over a one to three day period) is not pleasant, usually toxic and sometimes painful and traumatic.

Colonoscopies Destroy Bacterial Flora

But the really damaging thing about this kind of a colon cleansing is that it pretty much destroys your bacterial flora and balance of microorganisms in your colon. The average colon contains 3 – 4 pounds of bacteria. If you’re healthy, most of that consists of good, healthy bacteria. So the colonoscopy prep procedure has just stripped your colon of its good, protective bacteria. And guess what? Your colon is now wide open to secondary, or opportunistic infection by pathogenic bacteria, yeast, viruses, parasites, etc.

Into this now highly vulnerable colon, the doctor then inserts a colonoscope. This is a long tube that closely resembles a garden hose with a fiber optic camera on the end of it. But here’s what most people (including your own doctor) don’t know about colonoscopes: It’s impossible to properly or completely sterilize them.

Colonoscopes & Endoscopes Cannot Be Sterilized

It was actually Natasha Trenev (the founder of Natren probiotics) who first alerted me to this whole issue. We were on a TV show together when she told a story of how the Mayo Clinic had sent out letters to all its patients who’d had a colonoscopy – warning them that due to the inability to sterilize the apparatus, the patient might have been exposed to Hepatitis, AIDS, etc. I was aghast. Could this really be true? I began researching mainstream medical and scientific journals for evidence and I’m sure you’ll be as horrified as I was at the results.

But before we get into the technical medical jargon, let’s take a look at this newspaper article from the LA Times, where the reporter covered this exact issue:

UNSTERILE DEVICES PROMPT WARNINGS; Use of dirty endoscopes in colon and throat exams can pass along infections, activists say

- By John M. Glionna. The Los Angeles Times. Feb 13, 2003. pg. B.1

The nation’s leading manufacturer of endoscopes has known for a decade that some scopes contain cavities inaccessible to cleaning by hand but has failed to fix the oversight, said David Lewis, a University of Georgia research microbiologist who has conducted research for the federal Environmental Protection Agency on the issue of dirty endoscopes.

There is wide consensus that it is difficult to sterilize the devices, which can cost $28,000 each, without using temperatures so high that the scopes themselves become damaged. The scopes have numerous cavities that are difficult to clean, even by hand, critics say.

Acknowledged Timothy Ulatowski, an FDA official who oversees endoscope compliance: “When these things were designed, cleaning and sterilization was obviously an afterthought.”

Even the government can’t agree on how long is needed to clean the devices. The FDA says endoscopes should be disinfected for 45 minutes to kill tuberculosis bacteria, but the Centers for Disease Control believes the job can be done in 20 minutes, Lewis says.

He and other microbiologists advocate sterile disposable parts for endoscopes as well as the use of a condom-like sheath for each new patient. But they say manufacturers and health-care providers have resisted such solutions because of added costs.

Lewis says Olympus, which provides 70% of endoscopes on the U.S. market, has long been aware of cleaning problems associated with its product. In a patent filed in 1993, he says, the company wrote that at times “satisfactory cleaning cannot be achieved.”

You can read this newspaper article in full at:
http://www.sheller.com/NewsDetails.asp?NewsID=22zzz"
 

Bruce B

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The sterilization of endoscopes was a problem 8-10 years ago. Forget about a steam autoclave, the only other alternative was an Ethylene Oxide gas. This was much better, though the temperatures during sterilization can reach 140 degrees. The only alternative way to sterilize them was to soak in a Glutaraldehyde bath. A 20 minute soak is "not sterile", it's just a "high level of disinfection". To kill all the spores, you would need a 24hr. bath. Leaving an endoscope in for 24hr. breaks down the seals and after a month or so, you would end up with a door stop. A few years later came Peracetic acid (Hydrogen Peroxide/Acetic Acid) . This was much faster and more efficient than Glutaraldehyde, but it still wreaked havoc on optics, and seals.
The past few years there has been a shift to the "Sterrad" system. This is a Hydrogen Peroxide/Gas Plasma system. It doesn't have the heat problems of EO gas and total sterility is reached in about 22 minutes. The only caveat is if the lumen size of the biopsy/irrigation/insuflation port is longer than 110cm, then you need to "boost" the system.
 
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