Obesity doesn’t just cause serious disease; it also hinders medical procedures.

Colonoscopy is a very effective procedure for finding colon cancer.

Though the interior of a very overweight person’s colon looks the same as a thin person’s, there’s a reason why obesity can interfere with a colonoscopy procedure.

Obesity Is a Risk Factor for Colon Cancer

“The colon of an obese patient is not necessarily different to that of a patient of normal weight, and there is no way that we can predict a patient’s body weight based purely on the appearances of the colon as seen during colonoscopy,” says Santosh Sanagapalli, MD, a consultant gastroenterologist, endoscopist and specialist in esophageal disorders.

“However, colonoscopy can make the technical procedural aspect of colonoscopy more difficult.

“The difficulty of colonoscopy varies considerably from patient to patient.

“One major factor which hinders insertion of the colonoscope is termed looping.

“Looping is where the colonoscope loops around in the intestine instead of progressing forward as the gastroenterologist advances the scope.

“This can make it difficult to reach all the way to the end of the colon (cecum).

“Normally, when looping occurs, the gastroenterologist’s assistant can help counteract this by applying pressure to the abdomen with his/her hands, to prevent looping from occurring.

“In obese patients, it can be very difficult to effectively apply abdominal pressure — due to the abdominal fat tissue in between the assistant’s hands and the scope/bowel within the abdomen.

“An experienced gastroenterologist should usually be able to use alternative techniques in such a situation to minimize looping and reach the end of the colon.

“However, on average, the colonoscopy in an obese patient is likely to be more difficult; which in some situations might mean a less than perfect view of the colon is obtained.

“While this should not result in missing a colon cancer (which are usually very obvious), an impaired view might result in small colonic polyps being missed.”

When a Small Polyp Is Missed

If a polyp is missed, the findings will be deemed as normal, and the patient will be told that the next screening colonoscopy should be in 10 years (assuming there is no family history of colon cancer, which would reduce the intervals between screenings).

However, during that 10 years, the polyp that was missed – due to obesity compromising the view inside the colon – may have a chance to transform into a malignancy.

This would be called an interval cancer.

When interval cancers are discovered, a gastroenterologist would not know if it had sprung from a missed polyp 10 years prior, or if the malignancy had arisen from a precancerous polyp that began developing only at some point after the previous colonoscopy.

Lower the Risk of Colon Cancer

• If you’re obese or even moderately overweight, lose weight.

• Eat 25 grams of fiber a day.

• Don’t smoke.

• Get regular exercise.

• Never assume you’re “too fat” to have a colonoscopy.

Get regular screening colonoscopies; do not skip any.

Dr. Sanagapalli is a gastroenterologist and director of the Esophageal Disorders Center at St Vincent’s Hospital, Darlinghurst. He performs diagnostic and therapeutic endoscopic procedures, and enjoys providing comprehensive and holistic care to patients with a wide variety of disorders affecting the gastrointestinal tract.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.


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