The next issue of The Medical Letter (January 21) will include an article on the various methods of cleaning out the colon in preparation for colonoscopy. Almost everyone who has ever had a colonoscopy will testify that the preparation is the most unpleasant part of the procedure. One exception was a former member of our editorial board who developed pseudomembranous (Clostridium difficile-associated) colitis and had a colonoscopy without anesthesia (I never understood the rationale). His description of that experience (the colitis undoubtedly made a special contribution) was a forceful reminder of the blessings offered by propofol, midazolam, or whatever else is used to at least make us remember the preparation as the worst part of the procedure.
The last issue of Treatment Guidelines from The Medical Letter (December, 2012), not entirely by coincidence, was on the subject of Cancer Screening and of course included a section on screening for colon cancer. There we discussed some alternatives to colonoscopy, such as CT colonography, or “virtual colonoscopy”, which has the benefit of not requiring the propofol- or midazolam-blessed invasion of our inner space, but must also, at least for now, be preceded by ingestion of large volumes of unpleasant-tasting fluids. Our recommendation was, in effect, that everyone over 50 should have a colonoscopy at least every 10 years until they are 75. Since most colorectal cancers arise from adenomatous polyps in a process that takes about 10 years, 2 or 3 colonoscopies, or perhaps even 1 in the early-to-middle 60’s, could save most patients from dying of colon cancer.
Not having a colonoscopy at all is foolish, to put it bluntly. So we all should be well-educated on the vagaries of the various preparations for this potentially life-saving procedure. To achieve that in the briefest time possible, watch for the January 21st issue of The Medical Letter.