Dr. Berggreen talks all about colonoscopies with the Arizona Republic

All about Colonoscopy: A vital health-screening tool
by Alison Stanton

Experts agree that most people who have just celebrated their 50th birthdays should consider making an appointment for a colonoscopy.

“The standard recommendations from the American Cancer Society and the American College of Gastroenterology are that people with average risk should start having colonoscopies at age 50,” said Paul Berggreen, M.D., a gastroenterologist and president of Arizona Digestive Health in Phoenix. “There has also been an informal recommendation that African-Americans should consider starting at age 45 due to what seems to be a higher mortality rate from colon cancer than other ethnic groups.”

Berggreen said that individuals with symptoms or family histories of certain pre-cancerous polyps or colon cancer should consider having colonoscopies even sooner. “For these individuals, we recommend starting at age 40 or 10 years earlier than the age at which their family member was diagnosed.”

The purpose of the prep

Although stories about what happens before the procedure can have an urban legend quality to them, Berggreen said that it is mandatory that people have a really good prep.

We need to be able to see polyps that are sometimes just 2 to 3 millimeters in size and so gastroenterologists are adamant about adhering to the prep regiment,” he said, adding that most people drink four liters of liquid (typically a polyethylene glycol electrolyte solution) the afternoon and evening before the colonoscopy.

“It’s fair to say that the worst part of the exam is the prep. Everybody complains about that,” said John Garvie, M.D., gastroenterology department at St. Joseph’s Hospital and Medical Center in Phoenix. “It’s a huge amount of volume and people are not used to drinking that much liquid, so that is one thing they complain about. The patient is asked to drink the liquid over the course and 1.5 hours, about 8 to 10 ounces at a time.”

Tips to make it easier

About 30 to 40 minutes after drinking the solution, what Garvie referred to as “the purge” usually begins, continuing on for about 2 to 3 hours.

To make the prep as easy as possible, Berggreen suggested that the day before, people should stay away from solid foods, consuming only clear liquids like JELL-O, broth, and Gatorade.

Screening as well as symptomatic exam

Colonoscopy is often used as an asymptomatic screening exam, Garvie said, but it can also be used for specific symptoms like rectal bleeding, changes in bowel habits, and lower abdominal pain. The exam may also show Crohn’s disease, diverticulosis, and ulcerative colitis.

During the actual colonoscopy, Garvie said patients will be given an intravenous sedation, which is usually a combination of a narcotic and a tranquillizer.

“We are looking for polyps during the exam, which are basically like a bump. The bigger the bump is, the greater the potential for it to be meaningful, “he explained. “As the pre-malignant ones get bigger, the risk of them developing into cancer increases.”

Polyps that are found are removed and sent to a lab for examination, Garvie said. “We use a snare loop that opens and closes to get around the polyp and then we use electrocautery to cut it.”

Berggreen noted that colonoscopies may also reveal the presence of colon tumors. “If we find one, we take pictures and mark it by using tattoo ink around it,” he said. “Then we will take small samples for a biopsy.”

After the prep, the exam is a breeze

Berggreen stressed that although most people don’t like the thought of colonoscopies, the actual procedure is not a big deal.

“The exam itself is only about 20 minutes long and it’s really very easy. Most of the time it is done at an outpatient facility where it’s all the staff does all day so it is very efficient,” he said. “People are either asleep or in a twilight state and they are very comfortable. In fact, the most common question people ask when the exam is already over it ‘when are you going to start?’”

Source:  
Stanton, Alison. “All About Colonoscopies: A Vital Health-Screening Tool.” Arizona Republic Nov. 2011: Living Well Section, Page 4. http://arizonarepublic.digi-page.net/?id=LivingWell-Nov2011.