Making Colonoscopy Less of a Pain in the Ass

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Colonoscopies have become a rite of passage.  Age 50 is the standard for this to start, earlier if there is a personal or family history of cancer.

Why do colonoscopies matter?

  • Any problem takes less time and money to fix when caught early.
  • The 5-year survival rate for Stage I colon cancer is 92%.
  • The 5-year survival rate for Stage IV colon cancer is 11%.
  • At advance stages, in which part of the colon or rectum may be removed, the patient may be faced with wearing an external colostomy bag for collecting waste that has to be manually emptied and cleaned multiple times per day.  You would want to risk this why?

The traditional colonoscopy involves running a very long thin tube containing a light source and fiber optics (and other tools) up into the rectum and colon.  The tube is very thin, roughly 3mm to 5mm in diameter.  Optics in the endoscope enable the doctor to see the inside of the colon without requiring cutting to obtain access.  Sounds simple, right?

Originally, the procedure was performed with anesthesia, putting the patient to sleep.  Doctors were concerned that if the patient moved, the endoscope could damage the wall of the colon or rectum, requiring surgery.

It turns out that the risk of damage is very small, and the anesthesia may be more dangerous to patients than the procedure itself.  Thus, NIH and AMA guidelines have changed and general anesthesia is no longer required for this procedure.

“Although the absolute risk of complications is low, the use of anesthesia services for colonoscopy is associated with a somewhat higher frequency of complications, specifically, aspiration pneumonia.” (3)

(My wife is one of those who contracts pneumonia from general anesthesia.)

Many doctors and patients are unaware of the revised guidelines.  Anesthesia is dangerous, expensive, requires a longer recovery time from the procedure, and usually requires a second person to drive the patient home after the colonoscopy is completed, plus the risk of complications.

According to one study, most doctors see propofol (used for deep sedation) as worth far less than the $600 to $2,000 currently charged patients for its use.  This drug was also linked to the death of Michael Jackson. (1)

Colonoscopies have other drawbacks:

  • The discomfort and cost discourages many patients from having them.
  • Cancer clusters are not easy to spot and can be missed by the doctor.  Often, a color contrast agent is recommended to make them easier to see.

One of the stated advantages of colonoscopies is that if the doctor sees a polyp on the rectum or colon wall, he/she can remove it on the spot.  Polyps once were considered to be pre-cancerous objects, but some recent research has called that into question.  Polyps are common, but have less than a 1% chance of becoming malignant.

Patients with “hyperplastic” polyps may be at higher risk.

Now, there are options that make screening for colon cancer less expensive, less time consuming, less risky and less painful. 

  1. The Pill Cam:  a pill that can be swallowed and that can take pictures of the esophagus, colon and rectum as it travels through the system.  It’s the easiest method of screening, but it’s expensive, and difficulty in steering the pill can cause it to miss areas the doctor wants to see.
  2. Fecal immunochemical testing (FIT).  This is a chemical analysis of DNA in stool samples to look for cancer indicators.
    • The US Multi-Society Task Force on Colorectal Cancer has issued a unanimous recommendation for the use of FIT versus  traditional colonoscopy.
    • There are relatively inexpensive commercial kits for testing, for example, Cologuard.   According to one source, the maximum out-of-pocket for Cologuard is $649.  According to Blue Cross/Blue Shield of North Carolina, the average cost of a traditional colonoscopy is $3,081.  Private insurance and Medicare may absorb much of Cologuard cost.

So now you have no excuses.  Get it done.


Sources:

  1. Brooks, Megan, “Is expensive anesthesia for colonoscopy worth it?”  Health News, 25 July 2013.  http://www.reuters.com/article/us-anesthesia-colonoscopy-idUSBRE96
  2. Cologuard.  http://www.cologuardtest.com
  3. “Colonoscopy cost,” http://health.costhelper.com/colonoscopy.html
  4. Cooper, GS, et. al., ” Complications following colonoscopy with anesthesia assistance: a population-based analysis,” JAMA Intern Med., 8 April 2013, 173(7), 551-6.  https://www.ncbi.nlm.nih.gov/pubmed/23478904
  5. Enders, Gregory, MD, PhD, “Colonic Polyps,”  Medscapehttp://emedicine.medscape.com/article/172674-overview
  6. Hyman, NH, et. al., ” Hyperplastic polyposis and the risk of colorectal cancer”.
    Dis Colon Rectum. 2004 Dec;47(12):2101-4
  7. Nelson, Roxanne, “FIT: Excellent Alternative to Colonoscopy for CRC Screening,” Medscape.com, 26 October 2016.  http://www.medscape.com/viewarticle/870975
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4 comments

  1. As a rectosigmoid cancer survivor, I have to have a colonoscopy every year, and I’m telling you that I would never have one without anesthesia. In Canada there is no debate. They put you out.

    Like

    • I can totally understand that. When I had my first one done (I also had my esophagus done at the same time), there was never a question raised about whether anesthesia would be used. I only became aware of issues with anesthesia when I met Lyn and her problems with pneumonia (her last 8 surgeries have been done using nerve blocks only, including a prolapse procedure). There have been patient deaths attributed to anesthesia issues on otherwise routine procedures, so the concerns are not just for cost.

      Liked by 1 person

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