Colonoscopy uses a long, flexible tube that is about the width of a finger. This tube is attached to a video camera to view your colon and rectum. If there is anything that looks abnormal, the gastroenterologist or colonoscopist can pass small surgical tools through the tube to take tissue samples for analysis and remove any polyps.
The goal of a colonoscopy is to identify and remove as many polyps as possible.
Watch Mark B. Pochapin, M.D., FACG, director of the Division of Gastroenterology at New York University Langone Medical Center, narrate a tour of a patient's colon during a colonoscopy where he discovers and removes a pre-cancerous polyp.
Colonoscopy is the only method that has been studied as an effective screening test for people with cystic fibrosis. Unlike other screening procedures, a colonoscopy can detect and remove polyps, which is one of the main reasons why it is the recommended screening procedure for other high-risk groups, such as those with Lynch syndrome.
Although less invasive, screening methods like fecal immunochemical testing (FIT) are not recommended for people with CF because there is a lack of CF-specific evidence to support their effectiveness. If you are interested in stool-based testing, it is important that you discuss this with your CF care team first.
Working With Your CF Care Team
Unlike the typical preparation for a colonoscopy, the bowel preparation for people with CF is more intensive than for the general population. People with CF tend to have thick, sticky intestinal mucus that makes it more difficult to clean out their colons.
If the colon is not properly cleaned out, the physician performing the colonoscopy may not be able to identify polyps and may even require you to repeat the exam. This is why it's important to carefully review the steps of a CF-specific bowel preparation with your CF care team so that your colonoscopy can be effectively performed the first time it is attempted.
Although the colonoscopy itself will be performed by a gastroenterologist or colonoscopist who is a clinical specialist outside of your CF care team, let your CF team know if you are planning to have a colonoscopy and encourage open communication with the physician performing your colonoscopy. Working closely with your care team and the specialist will help you coordinate your care by addressing your individual CF-specific needs.
CF-specific factors, such as lung function, level of cough, and mucus production, can all impact your screening decisions -- particularly when it comes to the type and level of pre-exam sedation you receive. It is important that all providers involved in your care communicate and work together prior to your colonoscopy so that you can make decisions about the level of sedation and other key factors.
Colonoscopy is generally a low-risk procedure, but there is always a small chance of bleeding and injury, such as colonic perforation, infection, and missed lesions.
“I typically say to my patients, 'There is no perfect test for colon cancer, and even with a good preparation, some lesions can be missed. Colonoscopy is the best test currently available to look for and remove colonic polyps, and to identify potential cancers.'” -- James Abraham, M.D., CF Gastroenterologist (adult), University of Minnesota
Although the benefits of colorectal cancer screening typically outweigh the risks, it is important to discuss colonoscopy screening with your CF care team and colonoscopist to ensure that colonoscopy is the right screening choice for you.