Bowel Prep for Endoscopy: learning from Mr. Ormond

Digestive endoscopy is a means of assessing the lumen of the digestive tract. Among other things, it allows the identification of lesions which would otherwise take years of growth before causing mechanical conflict and symptoms that would lead to study and diagnosis – like cancer. Endoscopy is, therefore, an invaluable tool in detecting pre-malignant lesions.

Lower digestive endoscopy includes exams with such designations as colonoscopy and proctossigmoidoscopy, exams which study parts of the large intestine, or colon, and rectum, accessed via de anus. The gut normally contains fluids of different consistencies (water, faeces, gas). In order to obtain a visual image through endoscopy, and before insuflating the gut with air, the patient is required to void the bowel, by ceasing the ingestion of drinks and foods which produce digestive residue and consuming cleansing solutions.

We are all different, on the one hand, and different hospitals and clinics have different preparation protocols, on the other. Age, concomitant medical conditions (such as heart and kidney disease, for instance) and the location and luminal compromise caused by a known lesion are parameters to take into consideration when indicating bowel preparation regimens.

What the patient should know is, whatever regimen is prescribed, it is in his best interest to comply as best as possible. Complying does not mean to insist beyond what is sensible – if intense colicky pain ensues that does not remit after bowel movements or if nausea and vomiting ensues that does not calm with slower ingestion of smaller quantities of drinking solutions then a doctor should be informed and appropriate orientation obtained. Otherwise, careful planning is called for prior to endoscopy: buying medication in anticipation; reading and clarifying instructions; understanding the result to expect.

The bowel is required to be clean for an informative exam. Any faecal residue makes examination difficult and important lesions might not be seen – it reduces the accuracy of the exam.

So, if you have to undergo a lower endoscopy, if you have to undergo bowel preparation, do it well the first time. If not, you risk having to repeat it and if you don´t something as important as a cancer might be missed.

Next time you prepare for lower digestive endoscopy: read instructions; make sure you understand them; buy your medication timely; start as soon as indicated; follow precisely; and make sure your bowel is prepared. In case you do feel significantly unwell in the process, seek medical attention – something might not be well and you might require observation. Increase all chances of getting the best results possible!