Understanding My Colonoscopy From the Inside Out

Understanding My Colonoscopy From the Inside Out
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Last week, I had my annual colonoscopy. With all the safety precautions in place because of COVID-19, this year’s procedure was different.

First of all, my husband had to drop me off and wait in the parking lot until I was done. Usually, he gets to laugh at my antics as I come out of anesthesia. He missed my wardrobe malfunction after I put my right arm through the neck hole of my shirt instead of the sleeve. Thank goodness my post-op nurse noticed before I walked outside.

Next, my gastroenterologist couldn’t discuss his findings with me in person. I didn’t have the opportunity to ask questions or get a sense of concern in his voice like I normally would. Instead, I had to rely on the message he left for my husband with details and follow-up information and compare it to his printed report.

I typically skim the report before filing it away, but this time, I studied it more thoroughly. I easily understood I had inflammation, ulcers, and polyps. But I needed to do research, especially on unfamiliar terms and references, to comprehend the results better.

The Boston Bowel Preparation Scale

In the report, the procedure description mentioned that I scored a nine on the Boston Bowel Preparation Scale (BBPS). Without a reference point, the number was meaningless.

I learned that the scale assesses how well a patient has prepped for the exam. The BBPS measures each of the three sections of the colon — right, transverse, and left — on a scale of zero to three.

A BBPS score of zero represents the presence of solid stool in the colon, making the intestinal lining — or mucosa — unobservable. With a score of one, the colon has some clean areas but might be stained or contain residual solids and/or opaque liquids. A two indicates the mucosa is observable with minimal residual staining, stool, and/or liquid. A completely clean colon scores a three.

I was relieved to have a perfect score after my doctor prescribed a different colonoscopy prep this year. Instead of drinking an entire gallon of prep in one sitting, I had to drink two half gallons eight hours apart. The last and only other time I did a split prep, my colon wasn’t clean. I had worried about the effectiveness of the new prep, but my BBPS score restored my confidence.

Lesions

Lesions occur in injured or diseased tissue. My colonoscopy showed two types of lesions: ulcers and polyps. I have several superficial ulcers in my transverse and sigmoid colon. The ulcers were nothing new. After my severe flare in March, I suspected they might be more plentiful or worse. I even hoped the presence of ulcers might confirm my theory that they were causing my elevated liver enzymes.

Left colon with ulcers
Ulcers and friability in my left colon. (Courtesy of Emmeline Olson)

I was surprised, however, by the numerous inflammatory polyps in my right and transverse colon. Inflammatory polyps are nonneoplastic, meaning they aren’t tumorous. While generally harmless, inflammatory polyps can increase the risk of colon cancer in inflammatory bowel disease patients.

Sessile polyp in descending colon
The 2 mm sessile polyp in my descending colon. (Courtesy of Emmeline Olson)

My gastroenterologist also found and removed a 2 mm sessile polyp in my descending (left) colon. A sessile polyp grows slightly flattened and has a broad base. “Sessile” merely refers to the shape of the polyp, not the type. I’ll have to ask my doctor more about it at my follow-up appointment next week.

Unfamiliar terms

In the report, my gastroenterologist repeatedly used three terms to describe my intestinal mucosa: erythema, granularity, and friability. Erythema and granularity describe the appearance of the lining. Friability explains the condition.

Erythema, granularity, and friability in the terminal ilium and right colon
From left, erythema, granularity, and friability in my small intestine and right colon. (Courtesy of Emmeline Olson)

Erythema refers to the reddening of the intestinal lining caused by enlarged capillaries. The condition often indicates inflammation.

Granularity describes an uneven and irregular surface of the mucosa. This happens when healed ulcers form scar tissue. Granularity is another indicator of active inflammation, especially when it appears with erythema. My gastroenterologist observed erythema and granularity in the end of my small intestine and my right colon, which he diagnosed as mild ileitis and moderate colitis, respectively.

A friable mucosa is inflamed and can easily bleed when touched. Again, my colonoscopy showed friability in my small intestine and right colon. My gastroenterologist also observed mild friability in my left colon.

The results

The tissue biopsies my gastroenterologist took from the affected areas of my small and large intestines came back negative for cancer. However, with the inflammation and lesions, I’m officially no longer in remission from Crohn’s. My disease has been worsening progressively over the past few years.

Because I’ve been on Remicade (infliximab) since 2008, my gastroenterologist had mentioned the possibility of changing my medication last year. We’ll discuss my options at my appointment next week.

Now that I have a better understanding of my report, I’ll also be able to ask him thoughtful questions about my results and future implications of my disease.

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Note: IBD News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health providers with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of IBD News Today, or its parent company, BioNews, and are intended to spark discussion about issues pertaining to IBD.

Emmeline is a 47-year-old Crohn’s warrior and primary sclerosing cholangitis survivor. Her column encourages patients and caregivers to advocate for better healthcare and educates readers about her rare autoimmune diseases. She also freelances as a communication specialist, offering writing, editing, and graphic design services. Emmeline (an Auburn fan) and her husband Patrick (an Alabama fan) enjoy watching SEC football and spending time with loved ones in Austin, Texas. Thanks to a liver transplant in 2017, Emmeline is training for her third-degree black belt in the Korean martial art Mu Sool Won.
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Emmeline is a 47-year-old Crohn’s warrior and primary sclerosing cholangitis survivor. Her column encourages patients and caregivers to advocate for better healthcare and educates readers about her rare autoimmune diseases. She also freelances as a communication specialist, offering writing, editing, and graphic design services. Emmeline (an Auburn fan) and her husband Patrick (an Alabama fan) enjoy watching SEC football and spending time with loved ones in Austin, Texas. Thanks to a liver transplant in 2017, Emmeline is training for her third-degree black belt in the Korean martial art Mu Sool Won.

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