March is Colorectal Cancer Awareness Month, a rallying point for members of the American College of Gastroenterology (ACG) and the GI community to bring attention to the lifesaving benefits of colorectal cancer screening.
Follow UCI Health gastroenterology fellow and ACG Evidence-Based GI ambassador Anoushka Dua, MD as she shares 48 hours in the life of receiving a diagnostic colonoscopy at the UCI Health Chao Family Comprehensive Digestive Disease Center.
Also, the ACG has issued updated screening guidelines for colorectal cancer in the March issue of The American Journal of Gastroenterology. Learn more: https://gi.org/education/educating-you-your-colleagues/colorectal-cancer-awareness-education-resources/
Hi, everyone. My name is Anushka Dua and I'm a gastroenterology fellow at the University of California Irvine and I'm also an AC G evidence based G I social media ambassador. Today, we are going to break down the steps of obtaining a colonoscopy and I will also share some practical tips for both patients and providers along the way. So what I did not tell you is that today is the day before my colonoscopy. Tomorrow, I'll be having a diagnostic colonoscopy. A diagnostic colonoscopy is different than a screening colonoscopy, which is done for colon cancer screening. A diagnostic colonoscopy is done to evaluate specific symptoms that someone's having. For me, it's rectal bleeding. Sometimes rectal bleeding is as simple as hemorrhoids, but you can never be too. In the last several years, we've seen a lot of young people below the age of 50 being diagnosed with colon cancer. Now, let's talk about diet. So in the few days before your colonoscopy, it's best to adhere to a low fiber, low residue diet. So this usually means avoiding things like salads, nuts, beans, whole grains, like whole grain breads, um cereal, granola, things like that. Um If you do that and follow that diet in the few days before the colonoscopy, it'll make the prep on the day before the colonoscopy go a lot more smoothly. Now, in the one day before the colonoscopy, you're usually advised to adhere to a strict clear liquid diet. So let me show you what that means and what I'll be eating today. So for breakfast, I'm going to start with some black tea. You cannot put any milk inside because then it doesn't make the liquid clear anymore. And then also for breakfast, I'm going to have some jello uh which is also a clear liquid and notice that I did not choose anything that's red or purple because that can be distracting for my G I doctor during the procedure tomorrow because usually those colors look like blood. So this is what I'll be having for breakfast, for lunch and for dinner, I will be having this chicken broth, um or bone broth. You can also use beef broth, vegetable broth, anything like that as long as there's no solid content within it. And then for dessert, I'm very excited about this. I'm going to have these lemon popsicles again. No red, no purple. And then otherwise during the day, I can drink water to hydrate or I can drink something like Gatorade again. No red, no purple. Essentially. Anything that you consume the day before the colonoscopy has to be a clear liquid, meaning that you should be able to see right through it. And now let's talk about arguably the most challenging part of obtaining colonoscopy, the bowel prep. So there are many different types of bowel preps. Some of them are available over the counter. So for example, Miralax and Gatorade is an example of an over the counter prep and others are available only by prescription from your doctor. There are different formulations of prep. Some of them come in liquid form, some of them come in pill form and even amongst the liquid preparations, they often vary in how much liquid you actually need to drink. Uh Some preps also are not safe for patients with heart disease or kidney disease. So you'll have to make sure that you talk to your doctor about which prep is safe for you because not one prep, that's all. So I'm gonna show you two different preps. Uh This prep right here is an example of a traditional prep which consists of 4 L of a medication called polyethylene Glycol. You may hear this referred to as go lightly try light new lightly examples. Um and the way this one comes when prescribed is it comes with a pack of powder that you pour into the container and then you fill the container up to the fill line with water. And this is the prep that you consume. This prep is in a different prep that is uh actually a lower volume liquid prep. And this one is. You may here refer to as soup prep. The way this one comes is with 26 ounce containers of liquid prep and 116 ounce cup. So the way you drink each of these is by pouring the liquid into the cup and then filling the cup all the way up to the fill line with water. And then you drink this cup and eventually you will then drink two more cups of water after that. So that's the way you drink each of these. Now, no matter which prep you consume liquid pill, whichever version, the best strategy that I could recommend to you in terms of prep to best clean out the colon is a split prep strategy. So that means drinking half the prep the evening before the procedure and the second half of the prep about 5 to 6 hours before the procedure starts though, your doctor will probably give you specific instructions about timing and that's the bowel prep. So now I'm going to go through some helpful bowel prep tips for you if you are a patient about to get your colonoscopy and for you if you are a physician and want to give your patients some advice about how to effectively bowel prep on the evening before the colonoscopy tip. One is to drink the bowel prep chilled. That is my personal preference tip two. If you're using a flavorless prep, consider mixing in something like crystal light into the prep to help with the taste. Remember not red, not purple tip three, buy some hard candies or some mints to pop in after you've taken each sip of the bowel prep to help with the taste. But remember no red, no purple tip four. Consider walking around while you're drinking the bowel prep. Walking helps the bowels move to allow the prep to move through your system. Tip five wear pants with an elastic waistband because you will have some urgency. So just make going to the bathroom easier on yourself. Tip six, if you have sensitive skin, consider using a cream like butt paste or Vaseline to apply down below for some relief from discomfort that may develop after having lots of bowel movements. So my procedure is at 7:30 a.m. tomorrow and right now it's about 5:30 p.m. So I'm going to get started drinking my bowel prep and it's recommended with this prep to drink one cup every 15 minutes. So wish me luck. So on the day of the colonoscopy, you'll wanna think about a couple of things. Firstly, if you opt to receive any medication for sedation, you'll have to make sure that you bring someone to accompany you to the procedure who can drive you home afterwards because you can't drive if you're sedated. So for me, I have my partner waiting nearby at a coffee shop and he's gonna pick me up when I'm done. The second thing I advise is that you are comfortable clothes because after you're, you're sedated and you're waking up, you're gonna have to get dressed all by yourself. Um, and so it's best to have comfy clothes. You're generally advised to arrive one hour before your scheduled procedure time to get settled in. Let's go. Hi, there. I'm here to check in for my colonoscopy. Anushka Dua. Hi, Dr Dua. Thanks for checking in early. That way we can get your procedure started on time. If you just follow me right. This way we'll get you into your gown and we'll get your IV started. Ok. Sounds good. All right. Follow me. Ok. Right. Here's your gown. It opens to the back. I'll give you the curtain for some privacy. Thank you. So, now let's talk about sedation since that's why I'm having this IV put in in general, there are four broad categories of sedation that can be used for colonoscopy. No sedation, moderate sedation, deep sedation, and general anesthesia. Yes, it is true. There are a number of people that opt not to receive any sedation for colonoscopies. You might choose this option if one, you have a number of medical conditions that make it unsafe for you to receive sedation. And if so your doctor will tell you two, if you are worried about the adverse effects, the risks of the sedative medications or three, if you can't find anyone to accompany you to your colonoscopy, that way if you're not sedated you can drive your cell phone for moderate sedation. This is also called conscious sedation and with conscious sedation, you're in a twilight sleep medications that are commonly used for moderate sedation include IV, versed IV, fentaNYL and IV Benadryl. These medications are given so that you feel comfortable during the procedure. You are not in any pain and that you have no recollection of the procedure after it's done. The medications are commonly administered by the nurse that's in the room under the orders of the gastroenterologist who's doing the procedure. And then we have deep sedation, also called monitored anesthesia care or mac. With this level of sedation, you are completely asleep. You may respond to stimulation but not purposefully because of the deeper level of sedation. There's an anesthesiologist or a nurse anesthetist present during the procedure to administer the medications and watch your vital signs very closely. Propofol is a common anesthetic that's used for this type of sedation. And then we have general anesthesia with this type of sedation, you are completely asleep and a breathing tube is placed to help you breathe during the procedure. This level of sedation is also administered by an anesthesiologist or a nurse anesthetist. And this type of sedation is generally used for longer, more complex procedures also has a higher risk of adverse events, adverse risks complications. So we tend to not use it for short procedures like colonoscopies. Hi, Anushka. How are you today doing? Ok. So Um I see we're gonna be doing a diagnostic colonoscopy for you because you've been having some symptoms of rectal bleeding. Um Do you have any questions before we start at this time? Doctor Reddy, who is going to perform my colonoscopy, asks me several specific questions about my symptoms so that she has a good understanding of what to look for during the procedure. Certain symptoms may also mean that she will take biopsies in various parts of the colon. She also confirms some of my medical history and medications to ensure that the procedure is performed safely. So the procedure itself is going to be pretty short 30 minutes to an hour and here I go. So here we are. And in the room during the procedure will be my nurse who will be administering medication, watching and documenting my vital signs during the procedure. A G I tech who will be assisting Doctor Reddy, my gastroenterologist with any tools needed during the procedure, repositioning me if needed and providing pressure on my abdomen if needed to help guide the camera through the colon. And lastly my gastroenterologist, Doctor Reddy, who will be doing the procedure. Ok. So we're gonna have you go ahead and turn on to your left side and then bring your knees all the way up to your chest. So I'll be receiving moderate sedation for this procedure because I'm a little bit uncomfortable with the deeper levels of sedation. And I feel confident that my gastroenterologist will guide administration of the medication in a way that makes me feel comfortable and groggy. Today, we're doing a diagnostic colonoscopy because Anushka has been having symptoms of rectal bleeding. Um However, while we're here, if we do see anything abnormal, like a polyp, we can take biopsies and send it to the lab for further analysis. Polyps are pre-cancerous growths in the colon that we because there's always a chance they can turn into cancer. We are seeing more and more young patients with polyps and colorectal cancer. So, if you are having any new symptoms, it's important to discuss with your doctor to see if you need further testing. Every procedure is a little different because everybody's colon is a little different. Um We use different maneuvers to help guide the, the scope through the colon. Um For example, we use the wheels to help turn left or right or up or down. And then sometimes we even need to apply manual pressure outside on the abdomen of the patient to help guide the scope to the right direction. Once we reach the top of the colon, we'll insufflate the colon with air which allows us to inspect thoroughly as we slowly withdraw, looking for or any abnormal lesions or in Anushka s case, any cause of bleeding. Firstly, we have forceps which can be used to remove very small polyps or take biopsies of anything that we see is abnormal. Then we have something called a snare, which is a looped instrument that opens up around a polyp, closes around it and cuts it out of the colon. We use this for polyps that are too large to be removed with forceps and it is the most common instrument used to remove polyps. Another tool that we use is a hemo clip. Sometimes there is bleeding or a small defect after the removal of a polyp. So we use a clip to close off the site. Hi, Anushka, you're all done with your procedure today. You did an excellent job with your prep. So, um I think we found the cause of your bleeding. You had some moderate size internal hemorrhoids. Um I think that explains why you've been having intermittent bleeding. I did find one colon polyp which was very small and we removed it today. So we'll send that to the lab and once the results come back, I'll let you know what we find. OK. Here's the report. Thank you so much. Have a good rest of your day. Thank you. After your colonoscopy is done, your doctor will typically come and tell you what they found and give you a report of all the findings. If your colonoscopy was done for colon cancer screening, you'll also get an update. Maybe an estimate about when your next colonoscopy should be depending on the number of polyps that were found. However, the polyps that were found need to be sent to the pathologist and reviewed under the microscope to determine what kind of polyps they are, the type of polyps and the quantity of polyps will determine when your next colonoscopy should be. We typically use an algorithm to try and estimate when the next colonoscopy should be depending on the quantity and the type of polyps that were found. So all together the whole colonoscopy experience from arrival to departure took about three hours. So pretty fast. And now I'm gonna tell you about a couple of things that are pretty normal to experience after you have a colonoscopy. The first is you might feel a little bit of pain, abdominal pain, some gas, some bloating that can happen because of the uh air that's used to inflate the colon for the procedure. Um passing gas helps with that. So it's pretty normal. The second thing is that particularly if there are polyps removed during your procedure, you might have a little bit of streaks of blood in your stool for a few days, that's pretty normal. Um However, if you do have kind of a lot of bleeding that's very persistent, particularly in the week after you had the colonoscopy, that can be worrisome. That's something called delayed postpolypectomy bleeding. And if that's the case, you should definitely call your doctor. Um The other thing I wanna tell you about is about diet. So typically after a colonoscopy, you can resume your normal diet, eat whatever you like make sure that you hydrate because you'll need to replace all those fluids that you lost during the colon prep. Um, and then the last thing is about medications. So, if you were on a blood thinner before your procedure, you'll probably wanna talk to your doctor and make sure that you get an idea of when you're able to resume that blood thinner. Um, and then also it's generally a good idea, especially if you had polyps removed or biopsies taken to avoid certain medications like the non steroidal anti inflammatory medicines, like Advil Motrin, Ibuprofen, Aleve things like that. Um, because that can increase the bleeding risk. And now I'm time, it's time to get picked up by my partner just gonna wait for him right here. And that was two days in the life of getting a colonoscopy.
