Why? Well there's a lot of fear, both of what they might learn and the preparation itself, according to this 2011 survey, and squeamishness about the procedure, which involves insertion of a thin, flexible instrument that allows a doctor to look at the inner lining of your large intestine. Cost used to be a big issue, but the Affordable Care Act now requires that many colonoscopies be covered without costs to the patient.
And there's the nuts and bolts of cleaning out the colon, which generally involves skipping dinner and breakfast before the procedure, and drinking two to four liters of a viscous liquid. It contains laxatives as well as electrolytes and various other things your doctor wants you to have. When faced with that, it's not hard to understand why a lot of people simply put the whole thing off. Even among people who start the preparation process, about 15 percent don't finish.
"All of the preps that are currently available require some combination of prolonged fasting, which we know patients hate...and also drinking two to four liters of salty, viscous, foul-tasting liquid, or taking a pill and drinking roughly the same amount of liquid," said L. Campbell Levy, a gastroenterologist and assistant professor of medicine at the Geisel School of Medicine at Dartmouth College.
Well, the first glimmer of an alternative way of preparing for the procedure emerged this week at the Digestive Disease Week conference, where Levy presented the results of a study on 10 people that involved the same generally-used laxative and a carefully prepared diet of solid foods and liquids.
The patients, aged 46 to 73, were given measured portions of cereal, pasta salad, pudding, juices, chicken consomme, a vanilla smoothie and a pina colada type drink spread across a normal lunch-dinner-breakfast eating schedule. Eight of the first 10 patients ate it all, and the other two consumed 95 percent of it. None reported bloating, nausea, vomiting or cramping.
When they examined the patients, doctors rated nine of the 10 cleansings "good" and one "excellent."
Yes, 10 people is too small a sample to conclude anything. The researchers had intended to test 30 patients but stopped their pilot study because the success rate was so high. Next will be a Phase II study at two places, involving 80 subjects. If that is successful, Levy said, a large Phase III clinical trial would follow.
The diet/laxative combo was put together by two other researchers at Dartmouth and approved by the FDA. Levy believes this is one of those situations when no one stopped to assess the way preparation for colonoscopy has been conducted for decades, even as the technology of the procedure itself has advanced. Now that someone has, the possibilities are at least promising.
This could have a real impact on public health and getting people screened," Levy said. "That's what I'm excited about."