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Making Colonoscopy (Slightly) Less Awful

A newly approved laxative-pill regimen could make the preparation phase not so distasteful.


Of the 7 million Americans a year who undergo a colonoscopy, it's safe to say that none looks forward to it eagerly.

Who would? Doctors insert a 5-foot flexible tube through the anus to inspect the rectum and the entire colon, or large bowel, looking for signs of cancer.

Yet the vast majority of patients, doctors say, find the colonoscopy procedure much less painful and stressful than they expected. What they complain about most is the "prep" they must go through to clean out the bowel before the 30-minute colon test.

The day before, patients typically have to consume a gallon of a salty oral laxative--marketed under cruelly upbeat labels like Golytely and Nulytely and available in "flavors" from lemon to pineapple. Alternatives include more-concentrated oral laxatives, such as Fleet's Phospho Soda, or magnesium citrate.

Soon patients will have another choice: an oral laxative in pill form, called Visicol (short for "visualize your colon"). Visicol was approved by the Food and Drug Administration last month and is expected to reach pharmacies by early January.

The appeal for patients is that they can pop tablets instead of drinking an oral laxative. The catch is that they must take up to 40 pills in two days and drink nearly a gallon of their nonalcoholic liquid of choice--water, juice, ginger ale, whatever.

"It provides us with another option," said Robert Burakoff, chairman of gastroenterology at Washington Hospital Center. He cautioned that the new pills are not a panacea. "You're still going to have to drink a lot of fluid."

Despite a company press release claiming that "prepping for a colonoscopy is now as easy as taking a pill," patients must take 20 tablets the night before and 20 more on the morning of the test--and drink a cup of any clear liquid every 15 minutes with each few tablets. Visicol's maker, InKine Pharmaceutical Co., hopes the dosage will be reduced after further studies of the drug, a spokesman said.

Studies have shown Visicol works as well as standard colonoscopy preps and is preferred by many patients because they don't have to drink a foul-tasting laxative. Doctors hope that will remove one of the obstacles that may keep patients from getting a colon test.

Colorectal cancer kills more Americans--56,300 a year--than any cancer besides lung. Yet it's one of the most treatable of cancers, if caught early. To cut the death toll in half over the next decade, cancer specialists and public health officials call for periodic testing of all Americans over 50. That effort takes advantage of a biological quirk of colon cancer: It usually begins as a benign and removable polyp detectable by colonoscopy.

Colonoscopy is the most reliable--and most expensive--test for colon cancer, because it allows a doctor to view the entire 5-foot length of the colon and the rectum. Fiber optic devices and tiny instruments within the viewing tube enable the doctor to inspect the colon, snip tissue samples and remove polyps. A similar test, called a sigmoidoscopy, explores the rectum and the lower part of the colon but can reach only about half of all colon cancers.

A study reported in a recent issue of Journal of the American Medical Assn. found that while colonoscopy is the most effective test, the most cost-effective colon cancer screening program--when all costs are tallied--combines sigmoidoscopy every five years with an annual stool blood test for people over age 50.

Like other phosphorus-based preparations, Visicol cannot be used by patients with heart failure or kidney disease. Those groups must use the standard preparation.

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