Colonoscopy 'my way': Preparation, anticoagulants, antibiotics and sedation

Colonoscopy was introduced in the 1960s. The facility with which this techn ique is performed has been enhanced by vast improvements in instrumentation . In spite of this, physician attitudes concerning colonoscopy have changed little over the past several decades. The diet for precolonoscopic prepara tion has not been altered for 30 years. Colonoscopists have a great relucta nce to use a new preparation instead of the 4 L electrolyte solution, perha ps because this was such a significant advance in colonoscopic cleansing, i ts predecessor being castor oil and enemas. Physicians continue to be wary of the patient who is taking acetylsalicylic acid in the absence of any stu dies that show that this is detrimental for polypectomy. The management of the patient on warfarin anticoagulation remains a subject for debate. As fo r antibiotic prophyraxis, mast endoscopy units do not have a standardized a pproach, although there are good guidelines that, if followed, should decre ase the risk of infective endocarditis. Sedation for the endoscopic examina tion is usually administered by the colonoscopist, although anesthesiologis ts may, in some countries (and in some defined areas of the United States) be the primary administrators of sedation and analgesia. The present articl e is a personal approach to the following issues: the preparation of the co lon for an examination, current thoughts about anticoagulation and acetylsa licylic acid, antibiotic prophylaxis for colonoscopy and the technique for sedation out of the hospital.