Relax, and skip the Exlax.
Nineteen years ago, I had my first colonoscopy. My then-wife and I had returned from a trip to California, during which I experienced an upset stomach that wouldn’t go away – the upsetness, not the stomach (actually, it remained intact, too, though I would have been happy to lose a few pounds). A gastroenterologist suspected the problem lay somewhere in that long, twisting rope of tubing called the intestines, and recommended a colonoscopy.
Fear or pain
I always hated the idea of being put to sleep – you might say I was gutless – and asked the doctor if the pain were tolerable. He usually administered an anesthetic that sent the patient into the twilight zone, he said, so that said patient was somewhat awake but wouldn’t remember the procedure. But no, the pain was not intolerable. I declined the drug, and the doc advised me an anesthesiologist would insert a needle in my arm and stand by, ready to feed the anesthetic into the vein should I need it.
The colonoscopy device was a new product, and a manufacturer’s representative stood by observing the procedure. I noticed a concerned, questioning look on his face, and wondered if my drug-free decision were wise. Nonetheless, the procedure was proceeding smoothly – until the camera-headed snake winding its way through my gut made a particularly sharp turn. Pain shot through me, and I turned pansy.
“Give me the juice,” I grunted urgently. They have to be careful with that stuff, and she released the drug into me gradually, though I wished for a slam-dunk that would render me senseless. Afterward, the doctor said if he’d known how sensitive my gut was, he would have insisted on the anesthetic from the outset. He biopsied an abnormality and would have it analyzed. A few days later, the biopsy showed cancer, he reported, and he would get back with me on the treatment options.
Colitis, not cancer
Yikes! I was not a happy cancer camper. Two weeks later, he called me into his office. The diagnosis was incorrect, he said. A re-examination of the tissue showed the problem was colitis, an inflammation treatable with an antibiotic. Whew!
Since then, I’ve had a couple more, scheduled colonoscopies, gently passing into unconsciousness for a half hour. A few months ago, my doctor performed a routine physical examination, and I asked if a colonoscopy were warranted. Nope. “We don’t do them anymore once a patient reaches 70,” she said. I didn’t know who “we” was, but as long as it included her, I didn’t much care. She said the risks outweighed the benefits in this new protocol, and I sure didn’t want to dissuade her from it. I suspect she was aware of research showing the colonoscopy to be a somewhat risky procedure.
Referencing the Journal of the American Medical Association, Dr. Marc Micozzi, formerly with the National Institutes of Health, said a study of 2,520 colonoscopies revealed 15 perforations of the colon occurred. That figures to one out of every 168. By comparison, no perforations resulted from 13,000 sigmoidoscopies, which are far less invasive. Indications of abnormalities requiring the more complete colonoscopy were found in only about 20 percent of the patients receiving them.
A FITting test
Fecal immunochemical test (FIT)
Other tests also preclude the need for colonoscopies, Marcozzi said. Most people are familiar with the FIT, which stands for fecal immunochemical test, which detects blood in the stool. Granted, collecting samples is not one of the sublime delights in life. But it’s pretty effective, finding 74 percent of the cancers and 24 percent of the premalignant growths in a clinical trial involving 10,023 men and women.
The color … fugheddaboudit.
The Cologuard test
However, in that same sampling, a new, similar test called Cologuard, approved by the FDA in August, detected 92 percent of colon cancers and 42 percent of premalignant growths. The FIT was a little better at avoiding false positive readings, proving correct 95 percent of the time compared to Cologuard’s 87 percent. But as Marcozzi pointed out, doctors can always order these two safe, noninvasive tests together.
In many of the advanced nations, Marcozzi wrote in his newsletter, sigmoidoscopy and the FIT are the most common methods of checking for colon cancer. But colonoscopy dominates in the United States, despite its dangers and higher cost. Ay, there’s the rub. Marcozzi didn’t say it, but other leading alternative doctors have: Colonoscopy is a lucrative procedure for doctors.
Curtains closing on colonoscopy?
Marcozzi’s conclusion: The Cologuard test and FIT, together with the sigmoidoscopy, obviate the need for colonoscopy except when cancer is detected. It should be a last resort.