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Colonoscopy prep may get less icky

  • Dr. Pedro Jose Greer (right) prepares to do a colonoscopy at Mercy Hospital in Miami. AP file



Washington Post
Wednesday, April 05, 2017

In a sense, children have had it better than grown-ups when it comes to patient-friendly care. They get to take flavored medications and at least one vaccine (oral polio) that is needle-free, with more probably on the way. Moreover, kids probably also still get the occasional lollipop (or stickers) for putting up with something that hurts.

There are no similar rewards for the rest of us, however, for certain medical procedures that can be painful, uncomfortable or downright disgusting. As a result, many adults simply avoid them. But this may be changing.

“Now that we’ve required insurance companies to cover preventive screenings, we have removed one important barrier – cost sharing – but we haven’t removed the unpleasant barrier, and that can be just as important,” said Jeffrey Levi, a professor of health policy at the Milken Institute School of Public Health at George Washington University. “Accessibility is not just about cost, it’s about making the process as easy as possible.”

Take the colonoscopy, for example. The complaint about this potentially lifesaving screening is always the same: The procedure itself isn’t so bad – it’s the prep.

Getting ready for this exam (in which a physician inserts an instrument into the large intestine to search for inflammation, bleeding, polyps, ulcers and tumors) requires a day of drinking copious amounts of a vile-tasting solution that jolts your body into hours of purging. (Having a lollipop handy here actually might help, but not a red or purple one; these can stain the colon and be mistaken for blood.) The idea is to clean out your digestive system so the physician can get a clear look.

Nevertheless, the experience can be dreadful, and apparently discourages many people from having the screening.

Data suggest that about 40 percent of the people who should get a colonoscopy don’t, mostly because of the prep, according to Douglas Rex, a distinguished professor of medicine at Indiana University School of Medicine. This is true both for those who have had colonoscopies as well as those who haven’t, “suggesting that the word is out,” he said.

But what if patients had something better-tasting to get them through that terrible day? Maybe it could help overcome what Rex calls the “final frontier of colonoscopy acceptance.”

Such a product probably is on the way, and it could be on the market within the next two years. Researchers are studying shakes (vanilla and strawberry-banana flavored) and food bars (lemon, white chocolate and coconut) that produce the same cleansing but without the nasty taste.

Patients in the early studies seemed to like them. Those drinking the new products were twice as likely as those who used the standard prep solution to be satisfied and four times as likely to recommend it, Rex said.

“It’s an attempt to make the prep easier and better-tolerated,” said Rex, principal investigator for the clinical trials. “The evidence indicates that the taste is a very substantial improvement over traditional preps.”

The drinks and bars were developed by ColonaryConcepts, a company co-founded by Corey Siegel, director of the inflammatory bowel disease center at the Dartmouth-Hitchcock Medical Center, and Joshua Korzenik, director of the Crohn’s and colitis center at the Brigham and Women’s Hospital in Boston. The goal of the new preparation is to “lower patient resistance to colonoscopies,” Korzenik said.

Less invasive screenings that don’t require a prep, such as stool tests, also are available. But they are not as effective as the colonoscopy and are more likely to miss abnormalities.

Mammography, which produces an X-ray picture of the breast, is another important diagnostic tool – it has helped reduce breast-cancer deaths by 40 percent in the United States since 1990, according to the American College of Radiology - that many patients don’t like. Most women find mammograms uncomfortable, and some even find them painful, because they require each breast to be squeezed between two plates to spread out the breast tissue and eliminate image-blurring motion.

Researchers in the Netherlands, however, are working on a “breast-friendly” method that uses inaudible sound waves to create a three-dimensional image of the breast while the patient lies on a table and the breast hangs freely in a bowl. The scientists have only just begun to study the procedure, which probably is at least 10 years away from clinical use if it proves as effective as mammograms.

Nevertheless, these approaches represent new efforts to make health care more palatable.

“Understanding patient motivation – how people perceive procedures and their responses to them – can be important research,” said Susan Czajkowski, chief of the health behaviors research branch of the National Cancer Institute. “The easier you make it for people, the more you can improve their adherence.”

Levi agrees. “The perfect screen has no value if it isn’t used,” he said.