Michelle takes you along as she prepares and undergoes her recommended colonoscopy procedure.
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Michelle: I lost a friend to colon cancer a couple of years ago. She was afraid to have her colonoscopy, or she just kind of put it off, and she was, I think 50, 51 when they discovered that she had colon cancer. And she was really, truly a fighter. Dr. John Garvie: The patients are kept on a liquid diet for the day prior to procedure. They are then given a oral preparation, usually a combination of an electrolyte solution, sometimes supplemented with some laxatives. That’s what Michelle had for the procedure. She had two liters of PEG, it’s called PEG solution, and then she also took some laxatives supplementing the liquids. She told me prior to procedure that it wasn’t that much fun. She got her prep in. She was on the toilet, I think she told me till the wee hours of the morning, but she felt like she had completely prepped out. Complete prepping is you will not have any more fecal material that you pass; you’ll basically pass a clear water. At that point you are cleansed and ready for the procedure. Michelle: So I am in pre-op right now, and they have taken my blood pressure and they have checked all my vitals, and they also put this red band on me because I have some allergies. It’s really important that you write down everything that you have, that you are taking as far as medication goes, and then as far as allergies go, and bring that with you to the hospital so that they know and you know and you don’t forget because sometimes you get so anxious and you will forget. But now, we are headed off to the endoscopy room. Dr. John Garvie: The role of colonoscopy has become central in the effort to reduce the risk of colorectal cancer. We know that the initial lesion of a cancer is a polyp. So, what we attempt to do at the time of colonoscopy is, we are looking for polyps, which essentially are anything that’s raised above the flat inner-lining of the bowel called the mucosa. So anything raised above that is a polyp, and polyps vary in their appearance, and they can be flat polyps—we call them sessile—or they can be on a stalk—we call them pedunculated-type polyps. In Michelle’s case—when we had reached the cecum which is the beginning of the colon, at that point we start our careful inspection for any lesions in the bowel. Just above the ileocecal valve, we identified a small raised bump on the colon, and it was at the 12 o’clock position. We looked at it with both the regular high definition and then with narrow-band imaging, which this new scope allows us to do. We then took a snare, and we removed the polyp with a snare. The first snaring, if people would note, actually looked like it was a little quick, and I felt like it was a little quick. We went back and we grabbed a little more tissue, and then we did a little more slow cauterize, or we removed that. The polyp was completely removed, and then it was lying in the residual fluid. We went down and we suctioned that residual fluid and we pulled, we suctioned back the polyp fragments, and they were placed into a trapping system, and then that material is then sent to pathology department for review. There were no further polyps found during the case. We saw a few small diverticulae, these little out-pouchings of the sigmoid colon. There were some inspissated stool; it looked like little pieces of stool had kind of buried into those diverticulae. We did a few biopsies in the sigmoid. There is some concern that there may be some underlying inflammation, and then the case was over. The question was raised about how long before we know what the polyp results are, usually two to three days. We get a report back, we have a chance to let the pathologist review it, and then we make the report to the patient. Michelle: I felt nothing. The sand man, our anesthesiologist, was wonderful, and I highly, highly, highly recommend that you do this. In fact, I insist that you do this, because as I have just discovered that I had a couple of polyps; never had them before, and I jus
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