High Tech Colon Assessment

pillcamCan Your Colon be Examined with a Pill?

Most of us know the recommendation by now: If you're at average risk for colon cancer, once you reach the age of fifty you should have a colonoscopy to screen for the disease, as well as precancerous lesions called polyps. But who wants to undergo this test? It's even less fun than mammography (an issue I can speak to), requires a day of preparation where it's almost impossible to leave the house, sedation and the need for a driver to provide transport home. Jokes abound about screening colonoscopy, and Katie Couric's courage notwithstanding, the majority of those eligible for screening choose not to have it.

So would the test be more acceptable if it just involved swallowing a pill, albeit a pretty big one? The PillCam measures 31 by 11 millimeters. (Read the fine print: bowel preparation still required.) This test merely requires swallowing the device, pictured above, and continuing to drink the same solution used to cleanse the bowel in traditional screening colonoscopy. As the "PillCam COLON capsule" makes its way through the GI tract it snaps pictures. The device is recovered by the patient and the images uploaded for analysis by the healthcare provider.

Capsule Endoscopy versus Colonoscopy for the Detection of Polyps and Cancer is published in this week's NEJM. Results were disappointing, with only about three-quarters of the lesions found at colonoscopy also identified with the device.

So it's looking like traditional colonoscopy is still the way to go, at least for now. Other topics we talked about this week include Disclosure of APOE Genotype for Risk of Alzheimer's Disease and Longitudinal Modeling of Age-Related Memory Decline and the APOE 4 Effect, also in NEJM, and Coronary Artery Calcification Screening and Active Commuting and Cardiovascular Disease Risk in this week's Archives of Internal Medicine. Until next week, y'all live well.

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Crystal October 11, 2012 at 2:32 am

The Gastroenterologist (the doctor who will be pomrerfing the colonoscopy), the Anaesthetist (who administers your sedation/anaesthesia) and a nurse will be in the room with you when the colonoscopy is performed.In order for your GI doctor to get the best possible view and make the colonoscopy easier, your large bowel (colon) needs to be cleaned out of all waste material, you will usually be instructed at your pre-admission appointment when to stop eating solid foods and to which type of fluids to take and drink and you will also be given a prep kit to take to clean out your bowel.Before the colonoscopy procedure, an intravenous line is inserted into the back of your hand or arm to provide medications that make you relaxed and drowsy (sedation or twilight anaesthesia). Although you will probably be "awake" during the procedure, the medications usually prevent you from having any memories of it. Colonoscopy is usually performed on a table. You will be lying on your left side with your knees tucked up to your chest. The colonoscope is gently inserted through your anus and up into the colon, and air is introduced to help the colonoscope pass. Once the colonoscope has reached the point where the colon joins the small intestine, your GI doctor slowly withdraws it while looking carefully at the colon lining. Photographs may/will be taken. The procedure generally takes 15 minutes to one hour.Sometimes during a colonoscopy, if colon polyps are found, they are removed and the tissue is sent for analysis to determine if the polyp is cancerous. Polyp removal or biopsy may cause excessive bleeding, which may require blood transfusion or re-insertion of the colonoscope to control the bleeding.After the procedure, you can expect some bloating, gas, mild cramping and discomfort, but this should be over in about 24-48 hours. You may be offered a drink and something light to eat about one hour after you are fully awake and usually you can go home after 4 hours or so depending on the hospital/centre where you are having your colonoscopy done.I would recommend that if you have any concerns or questions that you consult with your GI doctor before your colonoscopy.Good luck

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Eddie October 9, 2012 at 1:52 am

The Dr should have given you betetr instructions, and a prescription. Most people who have had a colonoscopy would agree that the preparation is the worst part, since during the procedure, patients are sedated or given "twilight sleep" so that they do not feel any pain or even remember the test. However, preparation is usually done at home, and it can be quite challenging.Why? The goal of colonoscopy prep is to eliminate all fecal matter from the colon so that the physician conducting the colonoscopy will have a clear view. There are several ways to achieve this, and some [doctors and patients will have their own methods that work best for them. There are, however, three main types of preparation: Golytely (also called Colyte, or Nulytely), phospho-soda, and sodium phosphate tablets (Osmo-Prep and Visicol).GolytelyThis preparation will require a prescription from the doctor.It consists of a gallon jug with a powder mix inside. The patient will fill the jug with water to make a drink out of the powder. The instructions are usually to drink one 8 oz glass of the mixture every 10 minutes until the entire gallon is finished or eliminations are clear. After the first few glasses, bowel evacuation (in the form of diarrhea) will begin. Before the gallon is finished, many people find that their evacuations are totally clear and all the waste material is gone from the colon.If eliminations do not become clear after the gallon is finished, an enema may be needed. Some people do experience nausea when drinking so much liquid, so the physician may prescribe an anti-nausea medication in case it is needed. Golytely now comes in several flavors to make it easier to drink.Phospho-sodaPhospho-soda is a powder that is available over the counter either by itself or as part of a kit that also includes a laxative and an enema or suppository. The physician performing the colonoscopy will give instructions on which type of kit to purchase.Three ounces of the Phospho-soda liquid is mixed with water, or if the physician allows, other clear liquids such as ginger ale. After drinking the Phospho-soda mixture, most patients are instructed to drink at least 3 glasses of another clear liquids. If part of a kit, the rest of the kit (laxative, enema, or suppository) will then be used according to doctor's instructions.This preparation usually results in a bowel movement anywhere from 30 minutes to 6 hours after it is taken. Phospho-soda is also available in flavors to make it more palatable.Most physicians will instruct patients to call their office if the preparation does not progress as expected (for example there is no bowel movement at all or the evacuations never becomes clear).Sodium phosphate (Osmo-Prep and Visicol)Sodium phosphate tablets are prescribed by the doctor doing the colonoscopy. There are two different brands, depending on which your doctor prescribes Visicol, a 40-tablet regimen, and Osmo-Prep, a 32-tablet regimen.In Visicol, 7 doses are taken in 15-minute intervals: 3 tablets are taken for 6 doses, and then 2 tablets are taken for 1 dose (20 tablets total). The next morning, 3 to 5 hours before the test, the same dosage is repeated (3 tablets for 6 doses, and then 2 tablets for 1 dose in 15-minute intervals for a total of 20 tablets).The prep begins to take effect about an hour after the first dosage of tablets is taken. A liquid diet is usually prescribed starting about 12 hours before starting the regimen. Potential side effects include bloating, nausea, vomiting, and abdominal pain.In Osmo-Prep (the newer form), the tablets are taken on the evening before and the morning of the colonoscopy. The evening before the test, 4 tablets are taken with 8 ounces of a clear liquid every 15 minutes for a total of 5 doses (20 tablets total). The next morning, about 3 to 5 hours before the test, another 3 doses of 4 tablets are taken at 15 minute intervals (12 tablets total).Tips for the prep: * To reduce any anal discomfort, use adult wet wipes or a water spray to clean off instead of toilet paper. * Keep plenty of clear liquids on hand to drink. Water gets boring and you need to stay hydrated. * Follow doctor's instructions. You wouldn't want to have to do the prep all over again because you didn't get it right the first time. * Be prepared to spend most of the day before your test on the toilet. Bring a book. * Call the doctor's office for help if you have any trouble or don't understand the prep instructions.

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Jenay September 4, 2011 at 5:34 am

At last! Someone who understands! Thanks for psotnig!

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Colonoscopy September 17, 2009 at 12:39 am

Through a recent study, it has been found that a miniscule video camera implanted inside a pill could spot unusual growths in the colon or rectal region, but not as accurate as colonoscopy does. A scientist have stated that pillcam colon was safe, and can visualise the colon. If its really effective, then one can go for it.

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