March 21, 2019

The Colonoscopy Prep Test Challenge


How many times have you heard (or said)– “the colonoscopy isn’t bad, it’s the prep that I dread”?

Physicians like Dr. Adam Moskowitz, gastroenterologist at Guthrie Cortland Medical Center, hear it quite a bit. In fact, studies show that 40 percent of adults who should have a colonoscopy avoid it because of the preparation – fasting from solid foods for 24 hours and drinking nearly a gallon of unpleasant-tasting liquid flushes out your lower GI tract and cleans out the colon.

However, foregoing testing because it isn’t pleasant or because you’re afraid can be the difference between early detection and a life-threatening disease. Colorectal cancer is the second leading cause of a preventable cancer death in the U.S. 

Still agonizing over the prep? For individuals who dread the pre-screening prep, there are options.

Patients at average risk for colorectal cancer (no personal or family history of the disease or pre-cancerous polyps), Dr. Moskowitz says stool DNA testing is one option. “These tests look for changes in genes that can be found in cancerous polyps. A kit comes in the mail, you make a healthy donation for a sample and send it to the lab.” No bowel preparation required and there’s no invasive test. There is one caveat: a positive result doesn’t specify whether you have a one-millimeter polyp, or a four-centimeter mass and you’ll need a colonoscopy to determine that,” Dr. Moskowitz says.

Another at-home test looks for blood in the stool and is also a cancer or polyp indicator. Patients get a fecal immunochemical test kit from their physicians and take their own stool samples. No prep is needed but a colonoscopy will be ordered if the test results come back positive for blood.

If it’s the invasiveness of the colonoscopy that is a concern, Dr. Moskowitz says a colon x-ray or a virtual colonoscopy can be prescribed, though neither are completely non-invasive, and both require some preparation — a laxative taken the day before and a barium enema for the x-ray and a bowel cleanse for the virtual test. The virtual colonoscopy is a CT scan of the colon and rectum that provides images more detailed than an x-ray can show.

“The CT colonoscopy is a good test. It’s another option for people,” Dr. Moskowitz says. “And there are things I can do during a colonoscopy that I can’t do in a scan or x-ray, including removing small polyps right then and there.”

The likelihood of a serious medical problem stemming from the anesthesia and invasiveness of a colonoscopy are very rare and the hospital is fully equipped to handle a medical emergency should it arise, says Dr. Moskowitz. New methods to make the bowel preparation process less unpleasant may be available soon, including more palatable drinks in lower amounts, as well as food bars.

The bottom line is a colonoscopy is still the best method to detect colorectal cancer. “If you’re coming to me because Dad and Uncle Bob had colon or rectal cancer, I’m going to perform a colonoscopy. If you have bleeding in your stool or from your rectum, I’m going to go with a colonoscopy. And if any of the other tests show something positive, you will need a colonoscopy… so you might as well be pragmatic, and get it over and done with,” Dr. Moskowitz says.

For more information or to schedule an appointment, please contact Dr. Moskowitz at Guthrie Urology in Cortland at 607-428-5701.

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