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Done with colonoscopy and told not completely clean in one third of the ascending colon. Should I be worried?

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General Surgeon
Practicing since : 2008
Answered : 5762 Questions
Greetings. I just returned home from my colonoscopy. The doctor said everything was clear, except that just as in January 2010 I was not completely clean in "one third of the ascending colon." He said that any flat polyp would not have been detected there. He recommended another colonscopy in 2-3 years with more preparation to ensure the "one third" is perfectly clean.

In 2010 he removed one small polyp and said this time there was nothing found in the rest of the colon.
I presume that anything "small" and undetected in January 2010 in that unclean area would have been detected by today. What is unclear to me is whether should be anything to worry about, i.e. that something serious could be in that one third area from either PRIOR to or SINCE January 2010 that could still remain undetected now
Posted Sat, 24 Aug 2013 in Liver and Gall Bladder
Answered by Dr. Grzegorz Stanko 35 minutes later

Thank you for the query.

Please note that it takes approximately 10 years for the colon cancer to create. Most of the colon cancers are polyps first. But the risk of polyp conversion to the cancer is about 10% (for small polyps).

Polyps growing process is unpredictable. So you can not be sure that what was small and flat 3 years ago will become large and visible now. In conclusion unclean area of your large intestine remains not checked well. Any flat polyps (even present 3 years ago) may still be left undetected.

If your doctor suggested next colonoscopy in 2-3 years, you should follow his advice. During this 2-3 years nothing wrong with small, invisible in the last colonoscopy polyps(if any present) should happen (the risk is low).

Hope this will help. Feel free to ask further questions.
Above answer was peer-reviewed by
Follow-up: Done with colonoscopy and told not completely clean in one third of the ascending colon. Should I be worried? 14 minutes later
Thank you very much for this clarification. Why is it the case that the prep process which I followed exactly for both colonoscopies should leave some area not clean? The fact that it happened both times must suggest something unusual about my digestive system if most people do well with the basic prep process (drinking the two 129 grams of Miralax after the 2 Ducolax). Is this unusual, and are gastroenterologists supposed to consider redoing a colonoscopy on patients who have this phenomenon of not being 100% clean? Does colon cancer only emerge in the ascending colon or in any other location from polyps, or is it possible that it could emerge from other things? My mother's sister developed colon cancer at the beginning of her ascending colon at the age of 68 and had NEVER had a colonoscopy in her life. She had to have 12 inches removed but thankfully is healthy now, five years later
Answered by Dr. Grzegorz Stanko 25 minutes later
Well, the point is that every person is different. Every patient has different length of digestive tract. Also everyone has different diet. This causes different reactions for mentioned medicines. It does not mean that there is anything wrong with your digestive tract. You need to know that it is not so easy to well prepare large intestine for this test. And clean intestine is extremely important for this test.
If there is a stool in the large intestine, it can obscure some polyps.

Drinking 2x129 g of Miralax after 2 Ducolax usually allows to clean the intestine completely. Every Miralax should be dissolved in 1,5 liters of mineral water. If you want to be sure that your intestine is clean you should:
- have a liquid diet two days before the test
- one day before the test, take mentioned medicines, do not eat, have just liquids like water or tea
- the sign of clean intestine is clean water instead of stool

It is good to repeat such colonoscopy as the result is incomplete. So gastroenterologists may have consider it. However, like I have mentioned before, the risk of cancer being missed is low (but possible).

Colon cancer can develop in every part of it (ascending, transverse, descending, sigmoid colon and rectum). However most common localisation of it is rectum and sigmoid colon. Here is colon cancer frequency:
- rectum 30-50%
- sigmoid colon 15-20%
- ascending colon 15%
- transverse colon 10%
- descending colon 5%

96% of all colon cancer develop from the polyp. The great majority of colon cancer (up to 85%) is a sporadic (non hereditary). Your mothers sister case is a sporadic one and most likely non hereditary. It is because it appears in the age over 50.
We can suspect hereditary colon cancer if it appears in younger age. So your risk of colon cancer seems to be regular.

Hope this will help.
Above answer was peer-reviewed by
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