Transcription:
When Should You Get a Colonoscopy?

Bill Klaproth (Host):  This is Bill Klaproth in for Melanie Cole. So, when should you have your first colonoscopy and how often should you have one? Dr. Cynthia Yoshida is a board certified gastroenterologist whose specialties include colon cancer and colonoscopies. Dr. Yoshida, thanks for being on with us today. Now, I am of the colonoscopy age. I am over 50 and I’ve got to tell you, I have friends that say, “I’m not getting that. I don’t have colon cancer in my family. I don’t need to do that thing. I’ve heard it’s horrible.” Can you explain to us why it’s so important to get a colonoscopy?

Dr. Cynthia Yoshida (Guest):  Sure. Absolutely. I hear this all the time. People, even at cocktail parties, will stop me and say, “Why should I have a colonoscopy? I don’t have any symptoms. I feel great. I’m only 50. No big deal.” The real reason that we do this is just about screening. We know that all colon cancers, or the vast majority of colon cancers, start as little polyps which are benign growths. If we do a colonoscopy beginning at age 50, in the average risk population, we can actually find these polyps before they are going to turn into something bad—cancer. We can take them off before they do that. The colonoscopy is really the only screening test that we have out there that can find the pre-cancerous lesions before it turns into cancer.

Bill:  So, this is really a great form of preventative medicine. I mean, the way I look at it, the technology we have today, you’re not allowed to get colon cancer.

Dr. Yoshida:  That’s exactly right. It’s my job to make sure my patients don’t get colon cancer. It’s really though. There are sometimes, obviously, when polyps can be missed, but we work hard to find those polyps and take them off before they turn into anything bad.

Bill:  So, you mentioned the guidelines are starting at age 50. Are there any exceptions to that general rule?

Dr. Yoshida:  Sure. So, there are a number of exceptions. In African Americans, the American College of Gastroenterology actually recommends that African Americans start at the age of 45 because the risk is a little bit higher. People always think that there’s a difference between the sexes—between men and women. There isn’t. The risk is 50. If you have a family history of colon cancer, if you have somebody who is a first degree relative—so, somebody who is a child or parent or a sibling; a brother or sister who has colon cancer—you’re going to start 10 years before their age of when they were diagnosed with cancer. So, say your brother was diagnosed with colon cancer at age 46. You’re going to start screening at age 36.

Bill:  Alright, Dr. Yoshida. So then, how often should you get a colonoscopy?

Dr. Yoshida:  So, it’s different for different people. For most people who have no family history of colon cancer, if you have a great prep and we do the colonoscopy and don’t find any polyps, you don’t have to come back for 10 years. The reason for that is because from the start of a polyp to the formation of cancer, it takes a long time. It usually takes a number of changes for it to happen and it takes well beyond a decade for colon cancers to form. So, a ten-year window is absolutely fine for many people. If you have a family history of colon cancer in a first degree relative, say, a parent or a sibling or a child, then you need to come back every 5 years. If we find pre-cancerous polyps, it depends upon the number and the size of the polyp. For most people, it’s a 5 year window but sometimes if we find many polyps or bigger polyps, we could bring you back anywhere between 1 or 3 years.

Bill:  And, if you find a polyp, do you remove it right then and there?

Dr. Yoshida:  Yes. That’s the beauty of colonoscopy as opposed to other screening tests. There are a number of screening tests that are out there that they can look and see the polyps but with colonoscopy, we can actually see the polyps and we can also take it out at the same time.

Bill:  That’s terrific. For many people, really, the prep is worse than the test, right? 

Dr. Yoshida:  That’s exactly right. That’s what I tell people. When we’re doing the consent, I usually say to people, “You could back out now, but you’ve done the hardest part.” For the most part, having the colonoscopy is really just getting sleepy and comfortable and it really is a good nap and then somebody take you out to lunch.

Bill:  So, tell me, what can you expect before, during and after the colonoscopy? Take me through the day?

Dr. Yoshida:  So, the day before the colonoscopy, you have the prep. That really is the hardest part. We ask that our patients eat or drink only clear liquids for breakfast that day before. Then, that evening, you’ll take a prep. The prep is something called “go lightly”. It doesn’t always go lightly but it is a liquid that stays within your GI tract. So, you drink it. People have this misconception that we have to drink gallons and gallons of fluid. For most people, it’s 4-6 glasses the night before and then 4 hours before your test the next morning, it’s 4 glasses of prep. So, you usually start at about 6:00 pm and you’re going  to drink about 4-6 glasses of the prep slowly. Then, it will start to clear your bowels. Then, you go to bed and the next morning, you wake up prior to 4 hours before your procedure. You take another 4 glasses and then not eat or drink anything 2 hours before the test. It’s really important to remind your listeners that they really have to have a driver. It’s important  that they have somebody who can drive them home because they will be getting sedation and then, in order to make them comfortable, they’ll get sedation through the veins. So, most people will arrive at UVA at our endoscopy unit. They’ll register out in front and will be taken to the back to the endoscopy pre-procedure area where they’ll be met by a nurse and they’ll get basic vital signs. They’ll get your blood pressure and your pulse and you’ll get undressed. They’ll put you in a patient gown and we’ll start an IV. Then, usually, the physician comes in and will tell you all about the procedure; tell you about the risks and the benefits and tell  you why we’re doing the procedure and what we’re doing for that day. Then, we actually get you back into the endoscopy room itself. In that procedural area, again, we get you all connected to our blood pressure monitors, our heart monitors and our oxygen saturation monitors so that we can really closely watch you and monitor you during the procedure while you’re getting the sedation. The colonoscopy itself takes anywhere from 15-30 minutes on average depending upon what you have to do. Then, after the procedure, you go into the recovery area. Usually, in that area, you’re waking up and the nurses have some cookies and some juice and we get you fully awake and make sure that you’re tolerating what you’re eating and drinking. That’s the time that I come back and tell you exactly what we found, describe what we did and if there were any polyps found, what the follow up would be. Oftentimes, we send all the polyps to pathology. So, we’re going to need to mail you those results. I can usually tell by looking at them what I think they are and what the follow up is going to be.

Bill:  So, you can eat right after you’re done? You don’t have to have any special diet? You just normally after the procedure?

Dr. Yoshida:  Most people actually can. I have a number of patients who head out and have a hamburger right after. It depends on your tummy and how your belly responds to things but most people can eat pretty much back to normal.

Bill:  Alright. This may sound like a silly question, but maybe not. What if somebody has hemorrhoids or an anal fissure or something? Is that problematic?

Dr. Yoshida:  Those are common—for people to have hemorrhoids and they don’t interfere at all for our ability to do the colonoscopy. Oftentimes, what I tell people is the prep itself—because you’re going so much and wiping so much—that you may actually make your hemorrhoids a little worse during that period of time. After the procedure, we tend not to go for a day or so. So, it all makes up for it and they usually get better after that.

Bill:  Are there any complications ever? I’ve never heard of one—not that I would. But, are there any complications that arise during this?

Dr. Yoshida:  Sure. You know, the complications from colonoscopy are rare but it’s really important that people understand that this is an invasive procedure and that, I mean, you have to find somebody who is competent and excellent at this; somebody who has done a number of procedures. So, the risks of the procedures, though, are really:  bleeding, infection, poking a hole through the bowel; missing a lesion; a reaction to the sedation that we give you. They are very rare. The chances of them happening are extremely unlikely especially in the hands of somebody who has done a number of colonoscopies but it’s important—and this will be the part that the doctor will talk to you about before doing the procedure to get consent and to make sure that every patient understands what they’re having and what the possibilities are.

Bill:  Well, thank you so much for this great overview. You really explained it well. I really appreciate it. And, speaking of the great people at UVA, can you tell us  why patients should come to UVA for their digestive health needs and their colonoscopy needs?

Dr. Yoshida:  I think for their colonoscopy needs, the reason that they should come to UVA is that we have excellent, trained physicians who really care about colon cancer and colon health. We have a multispeciality group of people who are going to make sure that you have a great experience for your colonoscopy and if you have colon cancer or an issue that needs to be taken care of, we have a great group and great team of people that can take good care of you.

Bill:  Dr. Yoshida, thank you so much, again. I really appreciate it. For more information, you can go to UVAHealth.com. That’s UVAHealth.com. This is UVA Health Systems Radio. Thanks for listening.