LETTERS TO THE EDITORS
To the Editors:
The authors of “Blood, Guts, and Hope” (January–February) are to be commended for their innovative work on the treatment of inflammatory bowel disease, which can be very debilitating. However, their description of the colonoscopy procedure is needlessly barbaric. If this explanation accurately portrays the way it is done at the Brigham and Women’s Hospital, I invite them to visit any community hospital or outpatient surgery center in the greater Boston area to see how it is done in this century. Although there is more than one prep available, the most common one involves the use of polyethylene glycol, which is a powder that is tasteless when dissolved in a solution, typically a popular sports drink such as Gatorade. Whether the procedure is performed in an endoscopy suite or an operating room, the patient is typically lying on a mattress covered by a sheet, not a cold hard table, as the authors say. Both modern nursing care and anesthesia care pay attention to temperature homeostasis and patient comfort, and the patient is covered, often by warmed blankets. Although there are regional (and national) variations in the sedation used, typically short-acting agents such as Propofol are used, which usually wear off in minutes after the conclusion of the exam.
Although I suspect the authors were using some poetic license, its use in a technical article is to be discouraged, lest the uninitiated take any of it seriously. This could have the unintended consequence of discouraging someone who needs a colonoscopy from having one. Colonoscopy is important not only in the diagnosis of disease, as presented in the article, but in screening for colorectal cancer, one of the most common malignancies in this country.
Easley, South Carolina
Drs. Schoellhammer, Langer, and Traverso respond:
We agree with Mr. Morowitz on the steps taken during a colonoscopy. As he points out, we were trying to empathize with patients by emphasizing the inconvenience, invasiveness, and risk that can be associated with the procedure, particularly for patients suffering from inflammatory bowel disease, who can require more frequent colonic evaluation. We recognize how much progress has been made in ensuring maximal comfort for patients from the sedation and environment perspective, but we also recognize the challenges patients report with bowel preparation as well as post-procedural abdominal discomfort. We strongly believe in preventive care, and given that colonoscopy remains the gold standard for early detection of colon cancer, we agree that it is important. By no means did we intend to deter individuals from appropriate screening.