Colonoscopy

My Daughter is having her first Colonoscopy since first diagnosed 6yrs. ago. She's just dreading it.

The GI wants to do it, to better confirm her last MRE findings. Her disease has been in her terminal ilium, but the MRE showed activity in her Cecum as well.

Can the scope reach the terminal ilium now? I've been told it can, but forgot to question the GI about

Our GI also feels the the colonoscopy is the best of all the diagnostics.

 

Sometimes the scopist is unable to penetrate the ileocecal valve into the terminal ileum during a colonoscopy. Most of the time they can but occasionally they can't. Its not unusual that they can't.

I think we ALL dread that doggone prep for our colonoscopies. But once we get past the prep they are most always a piece of cake. If your daughter had difficulties w/the scope itself the last time she should discuss that w/her doctor BEFORE this scope to be sure that she is adequately sedated this time.

The most common meds for colonoscopies here in the USA are Versed for sedation and fentanyl or alfentanyl for analgesia. Some still use demerol for analgesia. They aren't sedating her heavily enough if she wasn't getting relief until they were almost done. She needs to discuss this w/her doctor before her next scope and again the day of the scope before they sedate her.

Endoscopy 2002 Jun;34(6):435-40

Patient pain during colonoscopy: an analysis using real-time magnetic endoscope imaging.

Shah SG, Brooker JC, Thapar C, Williams CB, Saunders BP.
Wolfson Unit for Endoscopy, St. Mark's Hospital, Harrow, London, United Kingdom.

BACKGROUND AND STUDY AIMS: Colonoscopy is generally perceived as being a painful procedure. Contributory factors are: stretching of the colonic wall and mesenteric attachments from looping of the instrument shaft, overinsufflation, the degree of torque or force applied to the colonoscope shaft, and patient pain threshold. The aim of this study was to determine the frequency of pain episodes experienced during diagnostic colonoscopy and the corresponding colonoscope configuration, utilizing real-time magnetic endoscope imaging (MEI).

PATIENTS AND METHODS: Consecutive outpatients undergoing colonoscopy were studied. Patients with previous colonic resections were excluded. Procedures were commenced with antispasmodics only, and patient sedation was self-administered whenever significant discomfort was experienced, using a patient-controlled analgesia (PCA) syringe pump. All "demands" were correlated with the MEI record, which was subsequently analysed.

RESULTS: A total of 650 demands were recorded in 102 patients. Seventy-seven percent of all demands occurred with the colonoscope tip in the sigmoid colon, 7 % in the descending colon, 6 % at the splenic flexure, 5 % in the transverse colon, and 4 % in the proximal colon. Ninety percent of all pain episodes coincided with either looping (79 %) or straightening of the colonoscope shaft (11 %); presumed overinsufflation being an infrequent cause of pain (9 %). Of the loops encountered during colonoscopy, the N-sigmoid spiral loop was associated with the majority of pain episodes (56 %). Looping was both more frequent ( P = 0.0002) and less well tolerated in women than in men ( P = 0.0140).

CONCLUSIONS: This study is the first to document pain at colonoscopy accurately. Looping, particularly in the variable anatomy of the sigmoid colon, is the major cause of pain, especially in women. Use of MEI may improve pain control by facilitating the straightening of loops within the sigmoid colon, and by enabling the endoscopist to target patient analgesia.

PMID: 12048623 [PubMed - indexed for MEDLINE]
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Gastrointest Endosc 1996 Feb;43(2 Pt 1):124-6

Why is colonoscopy more difficult in women?

Saunders BP, Fukumoto M, Halligan S, Jobling C, Moussa ME, Bartram CI, Williams CB.
Department of Endoscopy, St. Mark's Hospital, London, England.

BACKGROUND: In our experience colonoscopy in women is more difficult than in men. A retrospective review of 2194 colonoscopies performed by a single experienced endoscopist (CBW) showed that 31% of examinations in women were considered technically difficult compared with 16% in men.

METHODS: To investigate a possible anatomic basis for this finding, normal barium enema series from 183 female and 162 male patients were identified. From these barium enemas, measurements of colonic length and mobility were independently taken by two physicians who were unaware of each patient's gender.

RESULTS: Total colonic length was greater in women (median, 155 cm) compared to men (median, 145 cm), p = 0.005, despite women's smaller stature (p < 0.0001). Although there were no significant differences in rectum plus sigmoid, descending, or ascending plus cecum segmental lengths, women had longer transverse colons (female median length, 48 cm; male median length, 40 cm), p < 0.0001. There were no differences in mobility of the descending colon and transverse colon between the sexes, but the transverse colon reached the true pelvis more often in women (62%) than in men (26%), p < 0.001.

CONCLUSIONS: Colonoscopy appears to be a technically more difficult procedure in women. The reason for this may be due in part to an inherently longer colon.

PMID: 8635705 [PubMed - indexed for MEDLINE]

Is Imuran the only med your daughter is currently taking?

What Crohn's symptoms, if any, is she encountering right now and how difficult are they?

What meds has she taken in the past, since her Dx 6 years ago?

The next time she is scheduled for a scope she should be sure to discuss inadequate sedation for her AND share those two abstracts I included above. Hopefully her GI will read them and get the hint he's a bit ham-handed. These guys figure they have you sedated so you won't remember and they can just hustle right along, finish your scope and get on to the next scope. That stretching of the colon wall can leave a bruised feeling for a day or so and there is absolutely no need or excuse for that.

Is she still taking Pentasa along w/the Imuran? I'm one of those not so common tend to constipation crohnies as well. One graham cracker a day can often keep us fairly "regular". And/or one of those small individual serving size cans of prune juice every 3-4 days.

Yeah, well, for some of us Pentasa DOES still work. In my case I need to take both Pentasa and Imuran. If I cut out my Pentasa for a while just to get some relief from 16 capsules a day plus my other meds w/in 2 months or so Crohn's activity starts up. I hurry up and start taking my Pentasa faithfully and the symptoms start to subside and finally go into remission again.

Wow, now I'm all nervous for mine tomorrow....