Should you cancel your colonoscopy? (+3 facts)
By
Ivan Kahwa
Author bio
Mr Ivan Kahwa is a chemist and phytopharmaceutical scientist with expertise in chemistry, pharmacology, phytochemistry, and Nanobiotechnology. He writes and reviews content on these topics.
Mr Ivan Kahwa’s Highlights:
Guest Researcher at the University of Leipzig, Senior Research Fellow/Scientist, and Lecturer at the Department of Pharmacy, Faculty of Medicine, Mbarara University of Science and Technology.
Professional Experience:
Mr Ivan joined PHARMBIOTRAC as a research fellow/scientist during his master of science tenure. He contributed to the development of most of the phytopharmaceutical products in the project. Furthermore, he participated in carrying out the pharmacological activities of the developed products in laboratory animals such as mice and rats in order to develop proper doses hence leading to pre-clinical studies.
With the above relevant research experience, Ivan started to work with the University of Leipzig on collaborative projects with Mbarara University to develop the chemistry of Ugandan Medicinal plants and their pharmacological activities. This was coupled with several consultative positions by different German NGOs. Mr. Kahwa is also a supporting in the teaching and learning at the Departments of Pharmacy and Pharmaceutical Sciences, Faculty of Medicine, Mbarara University of Science and Technology.
With the increase in antimicrobial resistance globally, Ivan retooled his thinking towards developing new naturally derived antibiotic regimens from Ugandan propolis with the assistance of nanotechnology to improve their delivery to microbial cells. Kahwa has also published over 28 articles in peer-reviewed journals and he is currently reviewing for many journals.
Education:
2023-2027: PhD in Pharmaceutical Sciences (ongoing) with a focus on Pharmaceutical Microbiology and Nanobiology at Mbarara University of Science and Technology.
2022: 2Msc. in Pharmacognosy and Natural Medicine Science at Mbarara University of Science and Technology.
2018: Bachelor of Science (Chemistry) at Mbarara University of Science and Technology.
Publications:
▪ Iqbal, S., Jabeen, F., Kahwa, I., & Omara, T. 2023. Suberosin Alleviates Thiazolidinedione-Induced Cardiomyopathy in Diabetic Rats by Inhibiting Ferroptosis via Modulation of ACSL4-LPCAT3 and PI3K-AKT Signaling Pathways. Cardiovascular Toxicology. https://doi.org/10.1007/s12012-023-09804-7
▪ Gupta, A. K., Yadav, R., Sharma, S., Sawale, J., & Kahwa, I. 2023. Anti-ageing Activity and Antioxidant Activity of Methanol Extracts of Leaves and Flowers of Salvia officinalis and Rosmarinus officinalis. Journal of Young Pharmacists, 15(3), 448–455. https://doi.org/10.5530/jyp.2023.15.60
▪ Tolo, C.U., Kahwa, I., Nuwagira, U., Weisheit, A. and Ikiriza, H., 2023. Medicinal plants used in treatment of various diseases in the Rwenzori Region, Western Uganda. Ethnobotany Research and Applications, 25, pp.1-16.
https://ethnobotanyjournal.org/index.php/era/article/view/4683
▪ Kahwa, I., Ajayi, C.O., Yadav, R., Chauhan, N.S., Shah, K., Abdelgadir, A.A., Shegena, E.A., Daniel, S., Omara, T., Asiimwe, J.B. and Ikiriza, H., 2023. Pharmacognostic and phytochemical studies as an invaluable approach for correct identification of medicinal plants: The case of Artemisia vulgaris L. substituted for Artemisia annua L. in Western Uganda. TMR Integr Med, 7, p.e23004.
https://doi.org/10.53388/TMRIM202307004
▪ Nalimu, F., Oloro, J., Kahwa, I. and Ogwang, P.E., 2021. Review on the phytochemistry and toxicological profiles of Aloe vera and Aloe ferox. Future Journal of Pharmaceutical Sciences, 7, pp.1-21.
https://doi.org/10.1186/s43094-021-00296-2
▪ Elamin, O.H.S., Ali, M.A., Elgezuli, I.A.A., Bashir, M.A. and Kahwa, I., 2021. Diagnosis of pre-and post-treatment of echinococcus granulosus with counter current immune electrophoresis and bacterial co-agglutination. Journal of Microbiology and Infectious Diseases, 11(02), pp.88-94.
https://doi.org/10.5799/jmid.951600
Published book Chapter
▪ Kahwa, I., Ayesiga, I., Nakalema, S., Alinaiswe, R., Mbabazi, R. and Iqbal, S., 2023. Natural products in the management of onchocerciasis. In Natural Products in Vector-Borne Disease Management (pp. 63-80). Academic Press. Book Chapter.
https://doi.org/10.1016/B978-0-323-91942-5.00012-4
Submitted manuscripts Under Review:
▪ Comparison of the Wound Healing Activity of the Leaf and Leaf Ash Extracts of Vernonia amygdalina in Rats. Journal name: Clinical Phytoscience
▪ Ethnobotanical Survey of Medicinal plants used in the management of cancer in Uganda. Journal name: Journal of Herbal Medicine
▪ Ethnobotanical survey and phytochemical screening of medicinal plants used in treatment of epilepsy by PROMETRA-Uganda Traditional Health Practitioners in Mpigi District, Uganda. Journal name: Journal of Ethnopharmacology
Submitted book chapters under review
1.Book title: Algae as a Natural Solution for Water-Food-Energy Nexus, Section 4: Microalgae and cyanobacteria for food applications, Chapter 4.6: Safety, toxicological and allergenic aspects of using algae for food. Authors: Christine Kyarimpa, Tom Omute, Caroline K. Nakiguli, Alice V. Khanakwa4, Christopher Angiro, Ivan Kahwa, Fortunate Ahumuza, Timothy Omara*. Publisher: Springer Nature Singapore Pte Ltd. 152 Beach Road, #21-01/04 Gateway East, Singapore 189721, Singapore.
2.Book title: Nutraceuticals Inspiring the Contemporary Therapy for Lifestyle Diseases. Chapter: Nutraceutical applications of Seaweeds and their Phytocompounds in Nutrition and Treatment of Diseases. Authors: Ivan Kahwa, Timothy Omara , Innocent Ayesiga , Gael Noel Neh Neba Ambe , Zehbanaz Javidbhai Panwala , Rachel Mbabazi , Shabnoor Iqbal , Christine Kyarimpa , Christine Betty Nagawa , Kamal Shah ,Nagendra Singh Chauhan* Publisher: CRC Press
You can view my works on the following professional sites:
Research Gate: https://www.researchgate.net/profile/Ivan-Kahwa
Google Scholar: https://scholar.google.com/citations?user=tOwrvqoAAAAJ&hl=en
ORCID: https://orcid.org/0000-0002-6440-3437
Linkedin: https://de.linkedin.com/in/ivan-kahwa-865450159
In this article, we will discuss the situation in which you might want to cancel or reschedule your colonoscopic procedure. We will also discuss the situations in which cancelling the colonoscopic procedure would cause more harm than benefit.
Should you cancel your colonoscopy?
You may cancel your colonoscopy under certain circumstances. However, it is advised not to cancel your colonoscopy. Avoiding or delaying colonoscopy can delay the diagnosis and treatment of potentially dangerous diseases like colorectal cancer.
You may request a consultation appointment from a medical practitioner if you are experiencing unexplained symptoms, fear, or anxiety, or if you think your situation is complicated. In most situations, your medical practitioner will do pre-procedure consultation.
You can work with your medical practitioner to analyse the risks and advantages of doing a colonoscopy or determine whether other testing procedures and tests would be appropriate for the diagnosis of the underlying disease.
Under what conditions should you cancel a colonoscopy?
In certain conditions, it is not advised to perform a colonoscopy, including:
- Age: Most medical agencies in the United States believe that colonoscopy becomes irrelevant after the age of 85.
The benefits of screening disease through colonoscopy also decline after the age of 75. However, if the patient is in good health, and is at high risk of having colorectal cancer, then he might undergo colonoscopy (1).
- Hematochezia: A research study shows that colonoscopy had no significance in diagnosing hematochezia because the pathogenic lesions are usually located below the sigmoid colon (2).
- Irritable bowel disease: As no visible changes occur in the intestinal tissues, colonoscopy cannot be used for the diagnosis of irritable bowel disease.
- Cold and flu: If the patient has mild fever and cold symptoms then he should not cancel his colonoscopy.
However, if the patient is suffering from high-grade fever, chest congestion, sinus, and persistent cough then it is preferred to reschedule the appointment.
- Irreducible hernia: Colonoscopy is avoided if the patient has an irreducible hernia. In case of a reducible hernia, care is taken not to touch the hernia sac during the procedure.
- COVID-19: Although the COVID-19 virus mainly affects the respiratory system, it might also have gastrointestinal effects like pain and diarrhoea.
If the patient requires hospitalization due to severe COVID-19 symptoms then the medical practitioner would delay the colonoscopic procedure. It is safer to do a colonoscopy after 8-12 weeks (depending on the symptoms).
Under what conditions you should not cancel the colonoscopy?
In certain disease conditions, it is not advisable to cancel or delay colonoscopy, including:
- Colorectal cancer: If the patient is at high risk of developing colorectal cancer then he should not cancel the colonoscopy.
Because of the fear of colonoscopy and complex treatment, colorectal cancer is the second most common cause of cancer-related mortality in both genders.
- Iron deficiency anaemia: In the absence of overt blood loss, patients with iron deficiency anaemia should undergo a colonoscopy to rule out gastrointestinal malignancy.
- Chronic diarrhoea: Colonoscopy is often recommended for chronic diarrhoea to rule out colorectal cancer, and inflammatory bowel disease.
- Ulcerative colitis: Colonoscopy is often done in ulcerative colitis and Crohn’s disease to observe inflammation, and other signs of irritable bowel disease.
- Polypectomy: It is a technique of removing polyps from the colon with the aid of a colonoscopy. This reduces the risk of developing colon cancer.
Can a colonoscopy do more harm than good?
Patients often fear colonoscopy because of the prep methods, possible pain, and after-effects. Although colonoscopy is a useful diagnostic technique, it is often accompanied by harmful effects like:
- Acute cholecystitis: Mild abdominal pain, inflammation and discomfort might occur in 2.5-11% of the patients after a colonoscopy (3).
Acute cholecystitis after colonoscopy may be caused by decreased bile flow and gallbladder distention. Bacterial translocation might also occur due to mechanical forces and colonic interventions (4).
- Umbilical hernia incarceration: It is likely caused by increased intra-abdominal pressure due to colonic air distention.
This forces the small bowel into the hernia and compromises the blood flow. However, this condition is rarely reported (4, 5).
- Bleeding: Around 15/10,000 patients experience bleeding after colonoscopy. It is more common in patients with polyps and the elderly. Delayed bleeding might also occur after 2 weeks.
- Blood pressure: In some cases, the patient’s bowel preps may cause high or low blood pressure.
Before the colonoscopy, many patients get cold feet due to embarrassment and fear of pain. As a pharmacist, I always assure them that they will be getting appropriate intravenous (IV) sedation before the procedure.
The medical practitioner needs to talk with the patient and guide him about the benefits of colonoscopy in the most convincing manner. Try to relax the patient and adopt appropriate prep methods for colonoscopy.
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References
1.-
Wolf AM, Fontham ET, Church TR, Flowers CR, Guerra CE, LaMonte SJ, Etzioni R, McKenna MT, Oeffinger KC, Shih YC, Walter LC. Colorectal cancer screening for average‐risk adults: 2018 guideline update from the American Cancer Society. CA: a cancer journal for clinicians. 2018 Jul;68(4):250-81. https://acsjournals.onlinelibrary.wiley.com/doi/full/10.3322/caac.21457
2.-
Kim YW, Choi H, Kim GJ, Ryu SJ, Park SM, Kim JS, Ji JS, Kim BW, Lee BI, Choi MG. Role of colonoscopy in patients with Hematochezia. The Korean Journal of Gastroenterology. 2016 Feb 1;67(2):87-91. https://synapse.koreamed.org/articles/1007539
3.-
Shaikh DH, Kumar K, Patel H, Mehershanhi S, Makker J. Acute Cholecystitis, A Rare Complication Following Routine Colonoscopy: Case Series and Literature Review. Cureus. 2020 Oct 10;12(10). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7654559
4.-
Goodwin JS, Singh A, Reddy N, Riall TS, Kuo YF. Overuse of screening colonoscopy in the Medicare population. Archives of internal medicine. 2011 Aug 8;171(15):1335-43. https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/1106083
5.-
Gimeno-García AZ, Quintero E. Colonoscopy appropriateness: Really needed or a waste of time?. World journal of gastrointestinal endoscopy. 2015 Feb 2;7(2):94. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4325314/
