It is easy to talk about preventing colorectal cancer through healthy lifestyle choices and screening. But discussing how to get a good colonoscopy is a more awkward subject. Most of us will start getting routine colonoscopies beginning at age 50 — an important tool in the fight against colorectal cancer. Yet, no one really wanted to discuss their personal colonoscopy experiences with me. Though, one co-worker did offer up that her encounter with a colonoscopy “really wasn’t that bad” and suggested drinking the bowel prep laxative cold versus room temperature.
This leads me to the first step in getting a good colonoscopy: good colon prep. And with so many things in life, the first step may be the hardest. Prepping your colon usually involves dining on a special low-fiber diet and drinking what I’ll call a laxative punch (best served cold, according to the anonymous co-worker). A process that causes some “mild to moderate abdominal cramping” after partaking in the preparation and, more honestly, probably an unpleasant day spent in the bathroom.
“We know the prep required is a challenge, but a clean colon is essential for a good exam” says gastroenterologist Johannes Koch, MD, with VM’s Digestive Disease Institute. “If the colon isn’t properly prepped, the procedure can take longer, polyps and lesions may be missed, and the whole thing may need to be repeated sooner or even rescheduled.”
Dr. Koch also told me that good preparation is just one part of the quality colonoscopy equation. After the patient completes a good bowel prep, the endoscopist must do their part. “The most important part of an optimal colonoscopy is a careful examination of the entire colon by the endoscopist. Patients should ask the provider about their performance on key quality metrics/outcomes,” he explained.
There are several measures of quality outcomes beyond low complication rates, but the adenoma detection rate is one that is commonly used and easy to understand. During a colonoscopy, the doctor pushes the endoscope to the top of the colon and slowly withdraws it, looking for adenomas (aka benign tumors or polyps). When an adenoma is found (detected), it is removed during the procedure. According to the American Cancer Society, removing polyps can help prevent colorectal cancer from ever starting. Adenoma detection rate refers to the percentage of time at least one polyp is found during all the colonoscopies performed by an individual doctor. When this rate falls below 20 percent, the risk of colorectal cancer diagnoses in their patients goes up. Therefore, you want to get a colonoscopy from a doctor whose adenoma detection rate is at least 20 percent.
Of course your doctor’s adenoma detection rate loses much of its luster if you don’t receive timely pathology results from tissue samples taken during the procedure. Ask your physician how and when your results will be reported to you. You can also ask about the qualifications of the pathology team where your samples go for review and interpretation.
As with all preventive health screenings, the bottom line is that early detection saves lives, so be sure to do your part to help boost the process. Besides, no one should have to drink laxative punch without feeling assured that all significant polyps were removed.