INTERVIEW HIGHLIGHTS
Some newer colonoscopy preparation alternatives
Suprep is a low-volume prep, and the tablets are the other alternative. The liquid is typically 8 to 12 ounces of fluid. The concentration of the solution is higher, but it’s much less than the gallon we used to use more often.
One thing to know is that. some patients may have contraindications to the tablets. For instance, patients with renal insufficiency patients that have hypertension or diabetes that are on certain types of medications, typically ACE (angiotensin-converting-enzyme) inhibitors, have to be careful because they run a slightly higher risk of developing renal insufficiency.
So the tablets are great, but they're not for everybody. A physician has to make the call as to what's the most appropriate prep for the patient.
Another form of prep
Another prep that sometimes is used is magnesium citrate, which can be bought over the counter. It's a 6- or 8-ounce bottle of liquid.
It’s sometimes used on patients that struggle with constipation. You give the patient a bottle of magnesium citrate two days prior to the prep to kind of get them going. And then the gallon of Golightly was given after that. The purpose is to make sure you clear all the residue to have a good prep.
Other tips for colonoscopy prep
The patients that have more difficulty with prep are those who struggle with constipation. Most of the time, the patients take the prep the day before. But I tell the patients to instead take whatever laxatives they’ve used before, and that gets the colon kind of ready for the day of the prep.
The other thing that is very important is to avoid seeds: tomato seeds, poppy seeds, small seeds. Seeds tend to remain a little bit longer in the intestinal tract. When we are doing the colonoscopy, those seeds plug the suction channel in there, and it's very difficult to clear it and it makes the colonoscopy more difficult.
If they eliminate seeds a week prior to their colonoscopy and then two or three days, they eliminate anything that has high fiber content like corn or roughage like broccoli, which also helps to facilitate the prep.
Have these alternatives help to lessen resistance to colonoscopy?
I think they have. The compliance for colonoscopy is not up to where we would like it to be, but it has definitely made things more attractive for the patient to follow the instructions.
One more thing:
Don't let COVID-19 detract you from pursuing assessment. Unfortunately, COVID has had an impact on surveillance and that definitely has discouraged people from having their colonoscopy. Things are getting better with COVID, and people should now take the initiative to proceed with their colonoscopy.
So now the recommendation is for patients over 45 to proceed with colonoscopy or patients that have family history or other risk factors like inflammatory bowel disease or history of polyps to proceed with getting checked.
RESOURCES:
Colorectal Cancer Screening Tests
American Cancer Society Guideline for Colorectal Cancer Screening
Fretting About Colonoscopy? New Prep Is Easier to Swallow
The latest thinking on colonoscopy prep
New Colonoscopy Prep Tablet Approved by FDA
COVID-19 pandemic shifted patient attitudes about colorectal cancer screening
interview highlights were lightly edited for clarity.
Got a tip? Email Sam Baker at sbaker@kera.org. You can follow Sam on Twitter @srbkera.
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