What are the dangers of colonoscopy?

Written by christine lebednik
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Colonoscopy is a screening protocol for early detection of colorectal cancer. The medical establishment regards the colonoscopy as the gold standard for such screening, and most practitioners aggressively urge all patients to have regular colonoscopies starting either at age 50 or age 55. However, although the occurrence of adverse events as a result of the colonoscopy procedure itself are quite low, the colonoscopy procedure does involve some dangers to the patient. Colonoscopies involve four stages: the evaluation of the patient and physician of the appropriateness of the procedure during which full communication is imperative, the preparation stage, the procedure itself and the post-procedure stage. Dangers, though rare, can manifest themselves at each one of these stages.

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Practitioner Overzealousness

An important risk factor in colonoscopy is the zeal with which some physicians regard the procedure, particularly in terms of an asymptomatic screening protocol. Some physicians regard the use of screening colonoscopy for individuals starting at age 50 or 55 as a non-elective procedure. However, some expert writers do call into question the appropriateness of such colonoscopy screening for asymptomatic patients. The intense devotion with which some practitioners perceive the colonoscopy protocol can lead to disregard of factors in an individual patient's medical history which increase a particular patient's likelihood of experiencing adverse events as a result of the procedure itself. This overzealousness in some practitioners can even lead to disagreements between two or more physicians involved in an individual patient's care with the patient becoming ground zero between multiple physicians. This can cause unnecessary stress and anxiety for the patient.

Inadequate Practioner/Patient Communication

Perhaps the most frightening risk factor in terms of colonoscopy protocols, and one which tends to be a direct result of the first circumstance, is that overzealous practitioners may fail to communicate the potential dangers of the procedure to a patient at any time prior to the procedure and certainly inadequately beforehand for the patient to make a fully informed decision on whether or not those risks are acceptable. Such inadequacy in communication is suggestive of inadequate objectivity involving the use of the protocol itself: a factor which may elevate the objective risks that do exist.

Dangers During the Preparation Stage

Prior to a colonoscopy, the patient must fully evacuate the colon and bowels. This requires an extended fast as well as the use of bowel cleansing preparations while in a fasting state. For some patients the preparation stage may indeed involve the greatest dangers. People with metabolic imbalances such as thyroid conditions or diabetes can find fasting difficult and sometimes even dangerous. Certain medications also must be discontinued during the preparation stage; including some medications the discontinuation of which carries its own danger. Dangers of the preparation stage include weakness, nausea, vomiting, abdominal cramping, bloating, dehydration, adverse effects from use of the bowel-cleansing agents, and adverse effects from stopping medications normally regarded as essential. Patients have been known to experience dehydration serious enough in this stage as to be in danger of dying.

Dangers of the Procedure

Colonoscopy is an invasive procedure. Any invasive procedure involves dangers. While adverse colonoscopy events are generally rare, they do occur and some of the potential dangers are quite serious indeed. Patients with particular medical history factors may have increased likelihood of certain of the adverse effects. For example, patients taking angiotensin-converting enzyme (ACE) inhibitors, a popular high blood pressure medication, may have a higher risk of renal (kidney) failure.

Identified dangers of the colonoscopy procedure itself include reactions to the sedatives and-or narcotics administered potentially leading to adverse respiratory and-or cardiac events, gastrointestinal perforation, rupture of the spleen, acute anaemia, hemorrhaging, stroke, and gastrointestinal burn. A very uncommon danger, but one on record, is transmission of Hepatitis C resulting from improperly sterilised Colonoscopy instruments.

While rare, death can occur during the colonoscopy procedure. Most deaths during colonoscopy result from perforation, however, there is certainly potential for death from adverse reactions to the anaesthesia, or as a result of either hemorrhaging or stroke should the procedure precipitate those adverse reactions.

Post-Procedural Dangers

Colonoscopy dangers include post-procedural dangers, as well as those in the preparation stage and during the procedure itself. Perforation can occur not only during the colonoscopy but for several days afterwards, often associated with normal bowel activity as a precipitating event. Weakness, abdominal discomfort, and delayed reactions to the various medications and preparations used in the course of the procedure can also occur.

Additionally, one of the medications given, Versed, is given to induce amnesia of the procedure itself in the patient. Some patients have reported resultant memory problems for months and even years after a colonoscopy procedure. Some patients have also reported anxiety and mood issues after taking Versed. Although the medical community recognises that Versed can cause longer term memory issues, an article published by "Hospital Soup" states: "in most of the reported cases, these patients were not adequately informed about the possibility that Versed could cause longer term memory issues," substantiating an earlier point about the dangers of inadequate patient/practitioner communication with regard to the colonoscopy protocol.

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