• Mon, Jun 1 2009

Bowel Prep for Colonoscopy Hard for Obese

Colorectal cancer is the fourth most common cancer in the United States . It’s also one of the most detectable and treatable of all, with up to a 90% cure rate if caught in the early stages.

Most often, once a cancer starts showing symptoms, it’s advanced quite a bit. So, the best way to find early cancers is through proper screening. The way to find – and prevent – colorectal cancer is through screening colonoscopies.

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X-ray showing polyps

A long tube (endoscope) with a camera on one end is inserted into your rectum and then advanced slowly into your bowel, checking for anything unusual. The images are sent to a screen where the doctor can see the bowel lining. If something is seen, using the scope, the doctor can usually remove a piece of tissue to have it examined. Colonoscopies are also done to remove benign (harmless) polyps , which are overgrowths of tissue. These do have the potential of becoming cancerous, so by removing them, the risk drops.

Colonoscopies have their limitations. First, only the lower part of the lower intestine can be checked – the scope is only so long. And, most importantly, the bowel wall can only be seen if it is completely clear of any stool (bowel movement). If the bowels aren’t emptied completely, polyps or anything unusual on the walls may be missed.

Bowel preparation

It’s often said that the bowel prep is the most uncomfortable part of the whole test process. It involves taking very strong laxatives and limiting your diet for a couple of days before the exam. Unfortunately, this also means that you have to be near a toilet.

Some people have a harder time emptying their bowels than others. Some people don’t feel any abdominal cramping at all, others get bad cramps, and so on. Because of the seriousness of emptying the bowel properly, researchers want to know who is at higher risk of not being properly prepared. Their findings? People who are obese are often not properly prepped.

This is particularly serious because obesity is also a risk factor for colorectal cancer. People with higher risk factors should be screened more often.

According to a press release issued by the American Gastroenterological Association :

“The implications of our findings are profound. Since over a quarter of all patients had an inadequate examination, identification of a obese_womanpatient profile with a high risk for poor colon preparation will be helpful in capturing those who would benefit from an initial individualized designer preparation regimen,” said Brian Borg, MD, of Washington University in St. Louis, MO and lead author of the study. “Our results suggest that the obese patient should at least be subject to more precise instructions and possibly a more rigorous bowel preparation regimen. In addition, as the number of risk factors for an inadequate bowel preparation increase, the need for early repeat colonoscopy escalates.”

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