You know you should have a colonoscopy, right? Katie Couric says so. Your doctor says so. The US Public Health Service says so. Why haven’t you? The procedure itself is usually a piece of cake – you are sedated and the procedure is over before you know it. Colonoscopy is one of the few screening tests about which there is very little disagreement of its value.
One problem, unfortunately, in our crazy quilt “system” is cost. If your insurance does not cover it, the procedure will cost you thousands of dollars. If you have a high-deductible plan, the cost may run up to your deductible.
For everyone, regardless of insurance, however, the major factor that leads many to refuse the test is the dreaded “prep.” For the gastroenterologist to perform the test properly, you must have a clean colon. If there is a lot of fecal material still in the bowel, they may not be able to do the test at all, or they may do it but not be confident they have seen what they need to see. The standard way of achieving a clean colon has been to require you to drink a gallon of a foul-tasting liquid called GoLytely the day ahead. Most of my patients who did this once said they did not mind the colonoscopy itself, but that there must be a better way to a clean colon.
It turns out that there is. Many colonoscopists have begun using MiraLAX in Gatorade along with bisacodyl tablets in place of GoLytely. The taste is much better – you really only taste the Gatorade – and the volume to be drunk less. Instead of a gallon, the volume is halved – two quarts. This prep was tested in a trial in Boston and found to be as effective as the old standard and tested again at a community hospital in Michigan. In the latter study, about 400 patients who took MiraLAX/Gatorade were compared to a similar number using GoLytely. In both groups, about 90% had an excellent or good bowel cleansing. There is no getting around having diarrhea – no diarrhea, no cleansing – but with the new prep, the taste is clearly better.
So, as the commercials say: ask your doctor if is this right for you.
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