Prepping for a colonoscopy? You’ve got options

No one likes getting a colonoscopy, but for some, the prep can be worse than the procedure itself.

Do you dread the all- important “cleanout” the night before a colonoscopy, or have trouble tolerating that awful pre-colonoscopy drink?

You may have another option, according to Falmouth gastroenterologist X.Y. David Guo, MD.

Here’s how it works: You drink one portion of the prep the day before the colonoscopy and the second dose the morning of the procedure. This method is better tolerated and is now widely accepted.

Splitting the dose of the prep drink is a newer concept. “Instead of drinking a gallon all at once you split it into two parts,” he said.

Your medical history plays a big role in deciding which prep to use, Dr. Guo said. Doctors give special consideration to those with chronic diseases such as heart conditions, liver disease, diabetes, and renal insufficiency.

There are typically two types of types of drinks: PEG (polyethylene glycol), known as GoLytley and NuLytely, and Suprep, a combination of magnesium sulfate, potassium sulfate and sodium sulfate.

For those who can’t tolerate the prep or are averse to having a colonoscopy, there are still other options. Although not as accurate as a colonoscopy, they can be indicators that you should follow up with your doctor. Two in-home tests are available. The fecal occult blood test checks for microscopic traces of blood in your stool. A small amount of stool is tested with a chemical that changes the color of the fecal matter when blood is present.

Those results can indicate bleeding from ulcers, diverticulosis, polyps, inflammatory bowel disease, hemorrhoids, or benign or malignant tumors.

Cologuard, also called a fecal immunochemistry test, is “more sensitive and more specific,” said Dr. Guo. Cologuard tests for blood and DNA markers that are associated with colorectal neoplasia (a growth due to abnormal cell or tissue growth).

If the test is positive, it can indicate colorectal cancer and a colonoscopy is then required for a definitive diagnosis. Doctors recommend the test for patients 50 and older who are at average risk for colorectal cancer. This test can be done at home by collecting a stool sample and sending it to a lab. There is no need for preparation, diet or medicine changes.

“This is much better than doing nothing,” said Dr. Guo.

But Dr. Guo emphasizes that no test can replace the colonoscopy for the most effective screening. With advances in technology, the colonoscopy is one stop shopping. Doctors can now see 330 degrees of dimension in the colon as compared to 170 degrees with a traditional scope. This allows them the ability to visualize more polyps to remove and biopsy, especially in the folds of the colon.

The future of colonoscopies may change with advances in testing and technology. “I don’t think the colonoscopy will disappear,” said Dr. Guo.

And don’t expect to be able to avoid the intestinal cleanse. The prospect of swallowing a camera capsule to view the colon may be on the horizon, he said, but that ever-present cleanout will still be key.