Letter to the Editor: Canary in the Colonoscopy Mill

I’m a person who has a mammogram once a year.  As part of routine preventative health care, I also have a colonoscopy procedure in accordance with the national standards for frequency. Although only 8% of newly diagnosed cancers are colon cancers, early detection and treatment dramatically reduces death rates.  So colonoscopies are very valuable and I would want to continue to have them as recommended. 

What I have discovered is while the procedure itself may have minimal complications, the anesthesia used may put patients at unnecessary risk for aspiration pneumonia. While I have since learned of two individuals in Easton who developed aspiration pneumonia after their colonoscopies, my own complication was nodules on my vocal cords and laryngitis because of severe coughing as I came out of the anesthesia.  Not being able to speak was finally alleviated after six months of steroid injections in my vocal cords (extremely unpleasant) and voice therapy at Johns Hopkins.  

It was only when I investigated what had happened to me that I learned I was lucky.  The documented most frequent complication from colonoscopy with deep sedation is not damage from the colonoscopy procedure itself but the aspiration pneumonia resulting from the anesthesia.  And not just any anesthesia but deep sedation that is in recent vogue at endoscopy centers since it’s possible to do more procedures in a day than with the previously popular but less risky moderate sedation. (Cooper et al, JAMA Internal Med/vol 173:7. Apr 8, 2013)

What’s the big deal about deep sedation vs. moderate sedation?

Moderate sedation makes you drowsy cognitively but the protective reflexes in your throat which allow you to clear your throat and cough to protect your lungs from inhaling stomach acid etc. continue to function.   With deep sedation those reflexes do not function during at least 20 minutes while you are lying flat on your side so that when you wake up you are at risk of coughing severely to clear your throat of what has accumulated there (like me) or much worse than that, your coughing is unsuccessful and you aspirate acid or other stomach contents into your lungs leading to aspiration pneumonia. 

What to do?  Before your colonoscopy talk to your Gastroenterologist about the anesthesia you require and make sure the endoscopy center is prepared to provide that when you make your appointment.

This is a cautionary tale as someone who didn’t go through a Gastroenterologist and didn’t have the anesthesia options explained as the anesthesia provider was required to do.  

Holly Wright
Easton