The Perfect Colonoscopy and How to Get It

By: Christopher P. Shaver, MD

A colonoscopy is an endoscopic examination of your large intestine. The primary indication for the procedure is colon cancer screening. However, it is also an effective diagnostic tool for the evaluation of chronic intestinal symptoms including abdominal pain, diarrhea and rectal bleeding as well as unexplained anemia.

I perform more than a thousand endoscopic procedures every year with colonoscopy topping the list. I have also been on the receiving end of the c-scope. This makes me uniquely qualified to present to you my top four colonoscopy essentials:

1. A complete endoscopist. Whether gastroenterologist or surgeon, expect experience and attention to detail. One of the primary goals of colonoscopy is to significantly reduce the risk of colon cancer in the patient. This goal is accomplished by identifying cancer precursor lesions called polyps. These lesions are often flat or otherwise subtle and require patience and time to identify and remove. The art of colonoscopy involves the detection of elusive polyps and their subsequent safe and complete removal.

Sizeable flat lesions often require removal using a technique known as endoscopic mucosal resection (EMR). This technique requires advanced training and carries increased risks. A lack of skillful EMR may lead to unnecessary complications, extra procedures and even unnecessary surgery.

I call screening colonoscopies “polyp hunts.” While some polyps are inevitably missed, the goal is to kill them all. The complete endoscopist understands this and mercilessly works to eliminate them.

2. A clear prep. Absolutely essential. We can’t remove what we can’t see. Period. A couple of key points here include the following: A split-dose colonoscopy prep is preferred. Everyone orders it a little differently, but this clean-out strategy gives a clearer view of the colon, particularly on the right side. Yes, its different from the last time you did it. And yes there’s an extra step. But since the right side of the colon is where flat and aggressive polyps love to set up shop, it’s a small price to pay to improve the accuracy of your exam. Patients with chronic constipation or taking medications that slow bowel function may require enhanced bowel prep techniques including alternative products and an extra prep day.

3. Clean sedation. The endoscopic journey from anus to cecum is rarely a straight shot. More typically, the procedure is a series of sharp turns, loop reductions, twists and torques. The resulting bowel stretch along with air insufflation is well known to be uncomfortable to patients. Safe and appropriate sedation improves the quality of the experience and promotes a more complete and efficient procedure.

4. A first class environment. The backdrop for your colonoscopy is key. From the front desk check-in process to the wheelchair ride to your getaway car, expect to be treated with professionalism and compassion. The thought of having your intestinal tract broadcast on a large-screen, high definition monitor elicits responses ranging from nervous laughter to paralyzing fear. Don’t expect fuzzy slippers but do expect a friendly and comfortable environment; one that you want to come back to for your next perfect colonoscopy.