Painful colonoscopy

Except for the replacement of fiberoptic imaging with electronic imaging ( camera chip ) 'scope design has changed little in 30+ years. Cross contamination and cleaning are still big issues.

It will be interesting to see if Invendo ( invendo-medical dot com ) make progress into the market. My guess is that consultants & accountants wont want to know because each procedure may take a few minutes longer than the present method. Hope I'm wrong.

I dare say the number painful experiences would be greatly reduced if Propofol was used instead of Midazolam. This is common in some countries ( recovery time is much faster than Midazolam ) but not likely for anglo saxons as it requires an anesthetist to be present ( accountants wount like having to cough up for one of those )

Go easy on House. If you cant be a bit silly at 3:04AM when can you ?

Has anyone had a 'virtual' colononscopy? I believe it's an option.

"Has anyone had a 'virtual' colononscopy?"

Yes, The President Obama.

The americian society of gastroenterology were very down on him for 'sending out the wrong signal'.

Wonder might it have also been because radiology gets The Moola instead of endscopy?

Easthorpe, I am going to have a virtual colonoscopy tomorrow. I am currently doing the prep now. It will be interesting to see if I experience the same level of pain this time around. I hope this wont be the case because I will have to stop it again, then i'm not sure what options I have left. I will let you know how it goes.

I have been told that the virtual colonoscopy is a "safer" option that having it under GA but i am very skeptical about that since it is very common to do it under GA in America. There seems to be more risk with the radiation involved with the virtual colonoscopy.

I'm a bit confused when people say they were screaming out and the doctors ignored them or they were penned down. There is no way they could have done that with me, I literally started grabbing the scope and pulling it back out myself because of how painful it was. Normally I wouldn't dream of doing anything like that but when the pain is that bad instincts just take over. Either way, the patient should be allowed to stop the procedure at any time, the consent form even states that.

Jimsie, it will be very interesting to see what you think. I always imagine a virtual to be external tracking an internal enema as in an ordinary X-ray. Not sure how it would compare to the colonoscopy as I didn't need to go down that track in the end, but at least it would be more flexible for the bowel to deal with.

Good luck and best wishes for a smooth experience!

Rex -- Yer...Midazolam is good stuff and puts you in a happy place but doesn't block the pain receptors. You still need the same anaesthesia (local or general) to block the pain in any procedure. Otherwise the victim gets a journey to hell - albeit with a smile on their face while getting a pain in the a-bdomen. Trust me on this, as a victim who is not a winger or wimp.

Whether private or NHS the fee scales and timing for colonoscopies are tight; as others have said, protocols for administration and recovery for stronger analgesia and then recovery bust budgets.

Three big issues for the victims:

1) Is this procedure really needed?

2) What are the true risks? - Include consequences of perforation of the bowel and intolerance to sedation and anaesthesia

3) Could the procedure, if on balance seems like a good idea, be made more comfortable and safer?

I'd happily pay the price of a decent meal out in payment of the extra cost of better treatment.

Heresy, of course. Could never be discussed in public.

Easthope -- Yes, 'virtual colonoscopy' is easy. CT scan. So far they haven't invented an X-Ray machine that can remove a polyp from your bowel for path. So you are in the position of having your GP refer you to a gastroenterolist because the GP is concerned. The GE takes a 'virtual' scan and...you still end arse-up pinned into the cage with a robot up you butt. Ouch or no ouch· That is the question. Safe or unsafe? Please ask the jury in.....

Tom,

1. Clearly you were not given an appropriate amount of midazolam ( amnesiac ). If you had been you would not remember so much !

2. Yup, an analgesic is also needed. Thats were fentanyl ( or whatever ) comes in. Were you not shot up with some ?

3. Torture is OK if it makes a procedure cheap ? I dont buy this.

Also if fast recovery is an issue then why not use propofol instead of midazolam ?

"Whether private or NHS the fee scales and timing for colonoscopies are tight; as others have said, protocols for administration and recovery for stronger analgesia and then recovery bust budgets."

4. Not heresy at all. Screening colonoscopies have been questioned many times. I recall finding a paper a couple of years ago which made a very good case on public health grounds for not doing them. The Lancet published a paper some time ago which edged towards this position

( abstract at www dot thelancet dot com/journals/lancet/article/PIIS0140-6736(10)60551-X/abstract )

The guys who are not asymptomatic and need to have a 'scope deserve to have a reasonable experience. What court would accept 'saving money' as a valid excuse to commit assault ?

rex -- No. The sedation (e.g. midazolam) is not an analgesic or an anaesthetic. By your reasoning one could carry out major surgery with nothing but (sufficient) midazolam. As you know, that is not appropriate albeit better than a bottle of rum, all that was available in Nelson's navy.

Both propofol and fentanyl are, in the appropriate dosages and administration, general anaesthetics. Neither are particularly good analgesics in analgesic rather than anaesthetic doses....as has been discovered after many years of experience in palliative care.

The commoner opiates and opioids are better analgesics - pethidine in particular is a long-standing, well-understood and generally well-tolerated analgesic for simple procedures and can (legally) administered without the attendance of a qualified anaesthetist. Which, I guess, you know.

Unfortunately, not everyone is opiate-naïve. Many who have been suffering pain - the pain that led to this investigation in the first place - might have been palliated by the GP with compound opiates. That can diminish the effect of the intravenous opiate such as pethidine administered at the time of the colonoscopy. The same is true of midazolam, of course, for those who may have been taking benzodiazepines for unrelated complaints.For this reason, a guess dose of opiates and benzos is inappropriate. A good practitioner will be constantly aware of the comfort and condition of his patient and will add as required, through the cannula.

But one must not confuse between the legal status of 'sedation' and 'anaesthesia' because there are different protocols and the latter costs far more - not the drug itself but the administration and aftercare. Which, I suspect, you know.

Finally, in theory, the colonoscopy should be fairly free from major discomfort. However, a significant percentage of patients suffer from a ruptured bowel as a direct result of the investigation which often requires abdominal opening and major surgery. Which, I suspect, you know.

I question whether those patients who experience undue discomfort despite appropriate i/v analgesia and sedation are at greater risk of a rupture. Major abdominal surgery is serious and has potentially major risks and consequences.

Did you know this?

I had the virtual colonoscopy today and was much easier than the normal colonoscopy. It was just a bit uncomfortable when the air went in but honestly not painful. The woman doing it told me that they often get people who found the normal colonoscopy too painful, so its good to know that there is an alternative. I just have to wait a few weeks for the results now.

Brilliant Jimsie. Now I know what to ask for. Thank you and good luck with the results.

I'm pleased you had a pain free experience Jimsie. I wish we all could have had a virtual colonoscopy. I actually enquired as to whether I could have a virtual colonoscopy instead of the much more invasive colonoscopy procedure and was told I couldn't. In the words of the consultant I saw prior to my colonoscopy 'the virtual procedure was pretty useless as it didn't show the actual colon and didn't allow for biopsy or polyp removal should they find any polyps that could cause problems in the future'. I took from this discussion that the virtual colonoscopy was just that, i.e, 'virtual' as opposed to actual and my consultant also said the virtual colonoscopy method recreated a computerised impression of the colon and didn't allow for investigative procedures to be carried out. i.e, looking under the folds in the colon. An actual physical colonoscopy would I gather allow for 'hands on' investigation.

That is what I was told by the consultant who didn't for one minute seem to give any credit or value to a virtual procedure. Interesting to see how many people have had the virtual colonoscopy and their diagnosis and longer term prognosis compared to those having the physical colonoscopy.

All I know for sure is my procedure was the most painful experience of my life despite the usual administration of drugs described in most of the above posts. And by the way I also remembered everything during the procedure and doubt I will ever be able to forget it!

The virtual colonoscopy does have limitations like not being able to remove polyps or take biopsy's. But at least it will detect almost all polyps and any tumours so if the tests come back all clear then that is piece of mind. It's a much better option than avoiding a colonoscopy all together if you need one.

A previous person had 5 Midazolam ad 150 Fentalyn apparently but still had bad pain. It doesnt add u pmust be another reason for some getting lots of pain.The dose I had was 2 Midazolom 100 Fentanyl. Nurse said give more pain relief but doctor said he darent . Yet no pain when camera not moved fo split seconds or when asked to move position. Does that mean no enough air in bowel , when asked to pass wind non came. So failed sedation and pain relief also colonoacopy abandoned. There again perhaps the bowel prep may make the bowel extra sensitive in some patients even if so that should be covered with care.. Noted during so called after care some patients resting ok others still pretty uncomfortable like me. There doesnt seem to be enough thought gone into this, or why medication not working as it should. Am sure all staff feel they have got it right at the time. Mind you it wasnt fair when one patients record said it was tolerated when lots of pain was experienced as it is misleading to rest of medical staff. Unfortunately this does happen and records are believed.

osborne --

You become tolerant to both opiates and benzodiazepines. A fixed dose is absurd and a good practitioner will always watch the patient to keep him comfortable. The well-being of the patient is what it's all about. Bar nothing else. However there are risks and there are protocols. There are also really crap doctors. Maybe we need a 'TripAdvisor' kind of website to rate these people.

Pinning people down into the cradle, howling in pain, while the doctor sticks a probe into their anus is barbaric, unnecessary and legally actionable. It is time for the profession to listen and put this right.