In terms of new cases and cancer deaths, colorectal cancers (also called colon or rectal cancers) are the fourth leading cancer in the U.S.1 Almost nine in ten colorectal cancer cases are diagnosed in individuals age fifty and up. Since medical professionals claim that colorectal cancer is treatable with early detection, over two-thirds of American adults aged fifty to seventy-five opt to follow the Centers for Disease Control and Prevention’s (CDC’s) recommendation for routine screening in that age group.2
Routine colonoscopy (a type of endoscopy) is one of the primary tools used for colorectal cancer screening—and an estimated nineteen million are performed annually in the U.S.3 Judging by this number, it is probably safe to assume that most of the Americans seeking colonoscopies (or acquiescing to colonoscopy recommendations) are focused on the purported benefits of the test rather than its risks. The risks of colonoscopy are not insignificant, however. Experts from Yale University conservatively estimate that two of every one hundred twenty-five “otherwise low-risk healthy” colonoscopy recipients (1.6 percent) experience a complication—such as perforation, infection or hemorrhage—serious enough to send them to a hospital or emergency room.4 Other studies have found hospitalization rates within a month of colonoscopy as high as 3.8 percent.5 A 2010 study reported that the cost of these “unexpected” hospital visits “may be significant and should be taken into account in screening or surveillance programs.”6 But even more importantly, colonoscopy can come at the cost of one’s life7 (see “Fatal Complications” sidebar).
MULTIPLE SCREENING OPTIONS
There are three broad categories of colorectal cancer screening tests: stool tests called fecal occult blood tests (FOBT), sigmoidoscopy (insertion of a short tube into the rectum—the lower third of the colon) and colonoscopy (insertion of a longer scope through the entire colon). Providers frequently also use colonoscopy as a diagnostic tool when one of the other tests identifies a potential problem.
Researchers have stated that there is “insufficient evidence to identify which [colorectal cancer screening] approach is definitively superior,” asserting that none of the methods is “universally ideal.”8 Nonetheless, physician preference (buoyed by economic incentives) has caused colonoscopy rates to skyrocket over the past couple of decades; meanwhile, use of the noninvasive FOBT (which can be performed at home and has no known risks) has been declining, and sigmoidoscopy (with ten times fewer complications than colonoscopy) is experiencing “negative growth.”3,9-12
The CDC tells most adults aged fifty to seventy-five years to get a colonoscopy every ten years. However, if polyps are found (growths on the colon wall that doctors consider to be “precancerous”), the recommended testing interval shortens to every five years. Thus adults who follow the guidelines may undergo anywhere from three to six colonoscopies by their mid-seventies.4 This means, according to the Yale experts who studied colonoscopy adverse events, that “the risk [of complications] is even higher on a per-person basis” than the 1.6 to 3.8 percent calculated on a per-procedure basis.4
Only 5 percent of the most common type of polyp, called an adenoma, ever progresses to cancer (in a slow-to-unfold process that usually takes ten to fifteen years).13 However, the rationale driving colonoscopy is that “for colonoscopy to prevent cancer, the doctor must find and remove as many precancerous growths as possible.”13 Thus, gastroenterologists recommend removing “all the adenomas they find” during a colonoscopy, as well as removing—“just to be safe”—another type of polyp (hyperplastic polyps) not even considered precancerous.13 As practitioners like to put it, “If you get them at the precancerous phase, they don’t have a chance to grow and turn into cancer.”
In a Scientific American blog post published in 2012, titled “Why I won’t get a colonoscopy,” science journalist John Horgan (director of the Center for Science Writings at New Jersey’s Stevens Institute of Technology) questioned gastroenterologists’ gung-ho “remove it all” philosophy.14 A self-described “anti-testing nut,” Horgan pointed to research on PSA testing for prostate cancer, which shows that men are forty-seven times “more likely to get unnecessary, harmful treatments—biopsies, surgery, radiation, chemotherapy—as a result of receiving a positive PSA test than they are to have their lives extended.” Contending that a similar dynamic is at play with colonoscopy, Horgan tellingly quoted a UK National Health Service expert: “Invasive procedures may have fatal complications, while overdiagnosis—that is, the identification and treatment of tumors that otherwise would have caused no disease—may also result in death.”14
RISKS OF COLONOSCOPY SEDATION
During a thirty- to sixty-minute colonoscopy, gastroenterologists insert—through the rectum to the end of the colon—a long, narrow (about one-half-inch in diameter), flexible, lighted tube with a video camera on the tip to scan the colon for colorectal polyps. Ignorant of the fact that it is entirely possible to request (and comfortably survive) a sedation-free colonoscopy,15 the majority of patients agree to be sedated during the procedure. Gastroenterologists describe the purpose of sedation as twofold: On the patient side, clinicians claim that sedation “relieve[s] patient discomfort and anxiety” and (apparently this is desirable) “diminish[es] the patient’s memory of the event;” on the provider side, sedation reportedly allows providers to focus on “improv[ing] the outcome of the examination.”16
Traditionally, colonoscopy patients were put into a state of conscious sedation, with the gastroenterologist administering a drug cocktail containing a benzodiazepine and an opiate (fentanyl). In the mid-2000s, however, gastroenterology practitioners increasingly began shifting to deep or full sedation using a drug called propofol—the infamous drug that killed Michael Jackson and was also allegedly given to Joan Rivers shortly before her death. Yale Medicine estimates that 95 percent of colonoscopy patients now go under deep sedation.17
Doctors claim that propofol provides “ideal working conditions”—by sidelining the patient as a “moving target”—and helps physicians find more precancerous polyps.18 But because propofol must be managed by an anesthesiologist rather than the gastroenterologist, the cost of a colonoscopy can be anywhere from several hundred to two thousand dollars higher per patient.19 In addition, deep sedation comes with more physical risks to the patient. The use of propofol, according to Consumer Reports, is “overkill,” increasing the risk of aspiration pneumonia by almost 50 percent as well as the risk of side effects such as “confusion, seizures, irregular heart beats, and potentially deadly allergic reactions.”20
Studies indicate that sedation with propofol has notable parasympathetic effects, leading to a “significant decrease” in heart rate and blood pressure,21 especially in the older age groups that are colonoscopy practitioners’ primary bailiwick.22 Sedation researchers recommend that these effects be taken into account, “especially in patients at risk of cardiovascular complications.”21
Describing slow heartbeat and low blood pressure as “common side effects” of propofol, WebMD states that individuals who experience them “tend to have a severe expression” of these symptoms.23 Individuals who enlist for a simple outpatient colonoscopy may not even be aware of these risks, nor of the fact that if their heart rate goes too low, they may end up with a cascade of additional interventions and medications. For example, a drug called glycopyrrulate (brand names Rubinul or Cuvposa) is often used intraoperatively to “counteract” drug-induced arrhythmias.24
Colonoscopies require significant “bowel preparation” or “prep,” including eating a low-fiber diet for three to five days beforehand (“because fiber gets stuck in the nooks and crannies of the colon wall, and can block the doctor’s view”),13 fasting one day ahead (clear liquids only) and abstaining from all foods and beverages for the two to four hours immediately leading up to the procedure. In addition, gastroenterologists demand a “purge” the night before—facilitated by strong prescription or over-the-counter laxatives designed to produce “frequent, forceful diarrhea,” cramps and bloating as well as possible nausea, vomiting and aggravation of hemorrhoids.25 Under the circumstances, is it any surprise that three-fourths of colonoscopy recipients rate bowel preparation as their least favorite part of the process?26
As if the experience of “frequent, forceful diarrhea” were not bad enough, most of the leading colonoscopy prep solutions are composed almost entirely of a synthetic substance called polyethylene glycol (PEG). Though widely used in drugs, personal care products, food additives, lubricants and gels, PEG is coming under increasing scrutiny by researchers who question its biocompatibility27 and its association with adverse immune responses such as anaphylaxis.28 Case reports have linked PEG-based bowel preparation not just to anaphylaxis29 and hives30 but also to problems such as hyponatremic (low sodium) seizures,31 exacerbation of heart failure32 and kidney injury,33 among other reactions. A 2018 meta-analysis that compared PEG against a different bowel preparation before elective colonoscopy reported that patients were less able to tolerate PEG and experienced a higher prevalence of adverse events when taking it compared to the non-PEG option.34
A 2016 study in Analytical Chemistry published the unexpected finding that about 72 percent of contemporary human blood samples displayed sensitization to PEG—as ascertained by detectable and sometimes high levels of anti-PEG antibodies—that could set individuals up for adverse reactions when subsequently exposed to PEG-containing drugs or products.35 Worryingly, the researchers reported two pathways to PEG sensitization: (1) immediate sensitization induced through exposure to a drug containing PEG; and (2) pre-existing sensitization in individuals never treated with PEG-containing drugs but “most likely. . . exposed to PEG through other means”—such as colonoscopy bowel preparation?!
Notably, the two messenger RNA (mRNA) Covid-19 injections authorized for emergency use by the Food and Drug Adminstration, made by Pfizer and Moderna, contain PEG.36 [Editor’s note: See Vaccination Updates in this issue of Wise Traditions.] The FDA has acknowledged that PEG could be responsible for the anaphylactic reactions often observed following coronavirus vaccination.37
An additional concern related to colonoscopy bowel preparation is that the strong synthetic laxatives decimate the gut flora. Italian researchers who studied fecal samples one month after colonoscopy reported “clear evidence that, in normal individuals, a high-volume polyethylene glycol bowel cleansing preparation has a long-lasting effect on the gut microbiota composition and homeostasis, in particular, with a decrease in. . . a population of protective bacteria.”38 Posing a question about colonoscopy’s impact on the gut flora to the popular public radio show, The People’s Pharmacy, a woman stated that her sixty-year-old husband—“who takes no medication and is otherwise healthy”—had failed to recover healthy bowel function two years after a colonoscopy and was experiencing ongoing constipation, occasional loose stools and weight loss.39 Unfortunately, the poor man’s doctors then subjected him to a repeat colonoscopy to rule out intestinal disease!
MORE CHEMICALS AND CONTAMINANTS
Increasingly, colonoscopy patients and experts are also sounding the alarm about improper sterilization (“reprocessing”) of colonoscopy scopes, expressing concern that inadequately reprocessed instruments may be transmitting “superbugs.”40 In a 2013 review of “reported gastrointestinal endoscope reprocessing lapses,” the authors concluded that such lapses are an “ongoing and widespread problem” with “significant implications for patients, including. . . microbial transmission, and increased morbidity and mortality.”41 Moreover, even when there are no lapses and “the devices are cleaned strictly in accordance with manufacturers’ FDA-approved guidelines,” says a physician at the CDC, the scopes “have a lot of intricate mechanisms and pieces that are very difficult to disinfect.”42
A headline-attracting 2018 study published in the journal Gut reported that post-colonoscopy infections such as E. coli and Klebsiella were “more common than previously thought,” affecting one or two patients in a thousand— one hundred times more than previously assumed—and hitting those with a recent history of hospitalization especially hard.43,44 Even the CDC reports that “more healthcare-associated outbreaks have been linked to contaminated endoscopes than to any other medical device.”45 In the agency’s guidelines for the disinfection of health care equipment, it states: “Because of the types of body cavities they enter, flexible endoscopes acquire high levels of microbial contamination (bioburden) during each use.”45
Endoscopes (including colonoscopy scopes) are heat-sensitive. Thus, the CDC directs health care facilities to use FDA-cleared “liquid chemical sterilants and high-level disinfectants,” the most common of which are glutaraldehyde and a “liquid chemical sterilization process that uses peracetic acid.”45 But while the FDA may have okayed these sterilants, their routine use points to another, less-discussed explanation for the “infections” and other problems observed in the aftermath of colonoscopy—the disinfectants are toxic chemicals. Far from protecting patients, “sterilized” colonoscopy equipment introduces these toxic substances directly into the colon. As long ago as 1995, researchers reported an outbreak of hemorrhagic proctocolitis (inflammation of the colon with bleeding) induced by colonoscopes disinfected with glutaraldehyde, attributing the inflammation to “direct action [of the glutaraldehyde] on the mucosa.”46 More recent case reports continue to refer to glutaraldehyde-induced colitis47 and “chemical colitis.”48 Unfortunately, calls for the FDA to do more about the problem of endoscope cleanliness may do little more than usher even more toxic chemicals up the rectum.
CONSIDER NUTRITION INSTEAD
Considering the serious and potentially fatal risks posed by sedation, bowel preparation, perforation and the toxic chemicals used to sterilize colonoscopes, it is growing harder to argue that the colonoscopy’s putative benefits outweigh its risks. Why then do so many Americans continue to get one?
A blog that explains “why no sane person should do a colonoscopy” offers one compelling (and unsurprising) reason: “Colonoscopies are a multimillion-dollar industry.”12 The author points out that colonoscopies are the most expensive screening test in the U.S., “often cost[ing] more than childbirth or an appendectomy,” and that physicians get kickbacks for colonoscopy referrals. Moreover, cancer screening tends to generate new cancer patients.
The blog also points out something that is equally obvious to many—colon cancer is a lifestyle disease. Eating the foods that protect against cancer49—especially the high-quality animal foods and fats that conventional and even alternative nutritionists urge people to avoid—and staying away from the compounds in processed foods that can cause cancer are far more satisfying strategies for cancer prevention than the episodic chemical and physical assault that a colonoscopy represents.
One of colonoscopy’s potentially fatal complications is “iatrogenic colonoscopy perforation,” which is common enough to have its own acronym (ICP). Noting the increase in the number of colonoscopies performed around the world, researchers describe the occurrence of ICP as “not infrequent.”50 Because “many ICPs are not immediately recognized,” ICP can “lead to the development of secondary peritonitis, which is associated with significant morbidity and mortality”—with estimated ICP-related mortality ranging from 5 to 25 percent.50
In a revealing YouTube video titled “Death by Colonoscopy,” the white-coated narrator (apparently a clinician) criticizes the gastroenterology profession for masking the procedure’s true risks and confidently asserts that “hundreds of thousands of people suffer and die from colonoscopy.”7 Describing two kinds of death by colonoscopy—immediate and slow—he states:
Usually they do not report these cases of [immediate] death due to a colonoscopy; they usually classify it as “acute peritonitis” and “inflammation of the colon.” . . . The [slow] deaths from these complications also [are] reported from the doctors who did the colonoscopy as “severe intestinal infection” or “diverticulitis” and they never mention the colonoscopy as the primary cause of this condition. So the possibility of death after colonoscopy according to the gastroenterology doctors is between 1 to 2 percent. And I doubt too much these numbers.7
In a Yahoo news account of a fatal colonoscopy, the victim—talked into having her first colonoscopy at age eighty-three by her daughter—died of internal bleeding one day post-procedure after medical staff at the hospital allegedly ignored telltale signs of distress.51 After the daughter filed a complaint with the state and the findings were passed on to the federal Centers for Medicare and Medicaid, the latter classified the situation prevailing at the hospital as one of “immediate jeopardy” to patients.
VIRTUAL COLONOSCOPY: INDUCE CANCER TO FIND CANCER?
In recent years, the “virtual colonoscopy” has become available in some settings. The more costly x-ray-reliant procedure replaces traditional scoping with a CT scan of the “entire abdominal and pelvic area” that produces “hundreds of cross-sectional images of [the] abdominal organs,” which are then “combined and digitally manipulated to provide a detailed view of the inside of the colon and rectum.”52
Authoritative medical voices such as the Mayo Clinic promote the virtual colonoscopy as “minimally invasive.”52 However, an FDA webpage titled “What are the radiation risks from CT?” notes that “the increased possibility of cancer induction from x-ray radiation exposure” is one of the two “main risks” of CT scans.53 The Mayo Clinic discreetly admits that individuals who have a history (or a family history) of colon polyps, colon cancer or gastrointestinal conditions (such as Crohn’s disease, ulcerative colitis or diverticulitis) are not good candidates for a virtual colonoscopy.52
COLORECTAL CANCER IN YOUNG ADULTS
Since 1999, the age-adjusted colorectal cancer death rate has declined steadily, from twenty-one deaths per hundred thousand to fourteen deaths per hundred thousand presently. However, the cancer that historically has appeared later in life is, disturbingly, on the rise in young adults in their twenties and thirties.54 A 2017 study showed that individuals born around 1990 (that is, who are currently in their early thirties) “have double the risk of colon cancer. . . and quadruple the risk of rectal cancer” as adults born around 1950 (that is, who are currently in their early seventies).55 Some are predicting that by 2030, colorectal cancer incidence rates will be up 90 percent in young adults between ages twenty and thirty-four.56 Naturally, the explosion of young-onset colorectal cancers and other gastrointestinal diseases in the young is leading to calls for colonoscopy at ever-younger ages.57
Scientists are struggling to explain the surge in colorectal cancers in young people. As a physician from the Dana-Farber Cancer Institute noted at a September 2020 gathering organized by the National Cancer Institute, “When the incidence of a disease changes by generation, that suggests the culprit is something in the environment.”58 Given the lengthy lag time for abnormal cells in the colon wall to turn cancerous, it seems apparent that one must look to early-life exposures.
In addition to the heavy childhood vaccination schedule, Children’s Health Defense posits that one of the more likely environmental culprits is glyphosate due to the herbicide’s well-documented effects on the gut flora.59 Studies show “that individuals with colorectal cancer ‘display instability in the composition of their gut bacterial communities when compared with healthy controls’ and have elevated levels of unfavorable bacterial species,” some of which could have an impact on colorectal carcinogenesis.60 Researchers Anthony Samsel and Stephanie Seneff have described how glyphosate disrupts gut bacteria in animals, “preferentially killing beneficial forms and causing an overgrowth of pathogens.”61
- U.S. Cancer Statistics Working Group. U.S. Cancer Statistics Data Visualizations Tool, based on 2019 submission data (1999-2017). U.S. Department of Health and Human Services, Centers for Disease Control and Prevention and National Cancer Institute. www.cdc.gov/cancer/dataviz, released June 2020.
- Centers for Disease Control and Prevention. Colorectal cancer statistics. https://www.cdc.gov/cancer/colorectal/statistics/.
- An astounding 19 million colonoscopies are performed annually in the United States. iData Research, Aug. 8, 2018. https://idataresearch.com/an-astounding-19-million-colonoscopies-are-performed-annually-in-the-united-states/.
- Clark C. Colonoscopy complications occur at surprisingly high rate – Approaching 2% within a week of ‘scoping. MedPage Today, Feb. 16, 2016.
- Chukmaitov AS, Menachemi N, Brown SL, et al. Is there a relationship between physician and facility volumes of ambulatory procedures and patient outcomes? J Ambul Care Manage. 2008;31(4):354-369.
- Leffler DA, Kheraj R, Garud S, et al. The incidence and cost of unexpected hospital use after scheduled outpatient endoscopy. Arch Intern Med. 2010;170(19):1752-1757.
- Death by colonoscopy. https://www.youtube.com/watch?v=oUY9KcrTMxA.
- Maida M, Macaluso FS, Ianiro G, et al. Screening of colorectal cancer: Present and future. Expert Rev Anticancer Ther. 2017;17(12):1131-1146.
- Fecal occult blood test (FOBT). Medline Plus. https://medlineplus.gov/lab-tests/fecal-occult-blood-test-fobt/.
- Joseph DA, Meester RGS, Zauber AG, et al. Colorectal cancer screening: Estimated future colonoscopy need and current volume and capacity. Cancer. 2016;122(16):2479-2486.
- Centers for Disease Control and Prevention. Colorectal cancer screening rates remain low. Press release, Nov. 5, 2013. https://www.cdc.gov/media/releases/2013/p1105-colorectal-cancer-screening.html.
- Why no sane person should do a colonoscopy: Avoid colonoscopies! Cancer Wisdom blog. https://www.cancerwisdom.net/colonoscopy-dangers/#tab-con-6.
- They found colon polyps: Now what? Harvard Men’s Health Watch, Aug. 2013 (updated Sept. 10, 2019). https://www.health.harvard.edu/diseases-and-conditions/they-found-colon-polyps-now-what.
- Horgan J. Why I won’t get a colonoscopy. Scientific American, Mar. 12, 2012.
- Skipping sedation: A quicker colonoscopy. Mayo Clinic, Feb. 21, 2017. https://www.mayoclinichealthsystem.org/hometown-health/patient-stories/skipping-sedation-a-quicker-colonoscopy.
- Seleem WM, El Hossieny KM, Abd-Elsalam S. Evaluation of different sedatives for colonoscopy. Curr Drug Saf. 2020;15(1):20-24.
- Anesthesia for colonoscopy. Yale Medicine. https://www.yalemedicine.org/conditions/anesthesia-choices-for-colonoscopy.
- Scanlon S. Fight over colonoscopy sedation raises big medical questions. The Buffalo News, Oct. 14, 2019.
- Agrawal D, Rockey DC. Propofol for screening colonoscopy in low-risk patients: are we paying too much? JAMA Intern Med. 2013;173(19):1836-1838.
- Cooper L. Deep sedation for colonoscopy might not be safe. Consumer Reports, Nov. 19, 2014.
- Win NN, Fukayama H, Kohase H, Umino M. The different effects of intravenous propofol and midazolam sedation on hemodynamic and heart rate variability. Anesth Analg. 2005;101(1):97-102.
- Propofol and heart rate decreased – a phase IV clinical study of FDA data. https://www.ehealthme.com/ds/propofol/heart-rate-decreased/.
- Propofol side effects by likelihood and severity. https://www.webmd.com/drugs/2/drug-3519/propofol-intravenous/details/list-sideeffects.
- Glycopyrrulate injection. https://www.drugs.com/pro/glycopyrrolate-injection.html.
- How to prepare for a colonoscopy. WebMD, Feb. 14, 2021. https://www.webmd.com/colorectal-cancer/prepare-for-colonoscopy.
- Ko CW, Riffle S, Shapiro JA, et al. Incidence of minor complications and time lost from normal activities after screening or surveillance colonoscopy. Gastrointest Endosc. 2007;65(4):648-656.
- Betker JL, Anchordoquy TJ. The use of lactose as an alternative coating for nanoparticles. J Pharm Sci. 2020;109(4):1573-1580.
- Wylon K, Dölle S, Worm M. Polyethylene glycol as a cause of anaphylaxis. Allergy Asthma Clin Immunol. 2016;12:67.
- Hypersensitivity to polyethylene glycols & polysorbates. Physician’s Weekly, Dec. 30, 2019.
- Gökay SS, Çelik T, Sari MY, et al. Urticaria as a rare side effect of polyethylene glycol-3350 in a child: case report. Acta Clin Croat. 2018;57(1):187-189.
- Saradna A, Shankar S, Soni P, et al. Hyponatremic seizures after polyethylene glycol bowel preparation: the elderly at risk. Am J Ther. 2018;25(6):e779-e780.
- Ashraf S, Singh M, Singh M, Afonso L. Polyethylene glycol preparation for colonoscopy associated with heart failure exacerbation. Am J Ther. 2018;25(4):e495-e496.
- Cheng CL, Liu NJ, Tang JH, et al. Risk of renal injury after the use of polyethylene glycol for outpatient colonoscopy: a prospective observational study. J Clin Gastroenterol. 2019;53(10):e444-e450.
- de Paula Rocha RS, Ribeiro IB, de Moura DTH, et al. Sodium picosulphate or polyethylene glycol before elective colonoscopy in outpatients? A systematic review and meta-analysis. World J Gastrointest Endosc. 2018;10(12):422-441.
- Yang Q, Jacobs TM, McCallen JD, et al. Analysis of pre-existing IgG and IgM antibodies against polyethylene glycol (PEG) in the general population. Anal Chem. 2016;88(23):11804-11812.
- Redwood L. 5 questions Fauci and FDA need to answer on Pfizer and Moderna COVID vaccines. The Defender, Dec. 23, 2020. https://childrenshealthdefense.org/defender/fauci-fda-pfizer-moderna-covid-vaccines/.
- Kennedy D. FDA looking into allergic reactions reported after Pfizer COVID-19 shot. New York Post, Dec. 19, 2020.
- Drago L, Toscano M, De Grandi R, et al. Persisting changes of intestinal microbiota after bowel lavage and colonoscopy. Eur J Gastroenterol Hepatol. 2016;28(5):532-537.
- Graedon T. Will colonoscopy change your gut flora? The People’s Pharmacy, Feb. 4, 2019. https://www. peoplespharmacy.com/articles/will-colonoscopy-change-your-gut-flora.
- Alliance for Natural Health. Are endoscopes and colonoscopes killing people? Aug. 11, 2015. https:// anh-usa.org/are-endoscopes-and-colonoscopes-killing-people/.
- Langlay AMD, Ofstead CL, Mueller NJ, et al. Reported gastrointestinal endoscope reprocessing lapses: the tip of the iceberg. Am J Infect Control. 2013;41(12):1188-1194.
- Eisler P. Deadly bacteria on medical scopes trigger infections. USA Today, January 21, 2015.
- Reinberg S. Colonoscopies can cause greater infection risk. WebMD, June 6, 2018.
- Wang P, Xu T, Ngamruengphong S, et al. Rates of infection after colonoscopy and osophagogastroduodenoscopy in ambulatory surgery centres in the USA. Gut. 2018;67(9):1626-1636.
- Centers for Disease Control and Prevention. Disinfection of healthcare equipment: Guideline for disinfection and sterilization in healthcare facilities (2008). https://www.cdc.gov/infectioncontrol/guidelines/ disinfection/healthcare-equipment.html.
- Dolcé P, Gourdeau M, April N, Bernard PM. Outbreak of glutaraldehyde-induced proctocolitis. Am J Infect Control. 1995;23(1):34-39.
- Shih HY, Wu DC, Huang WT, et al. Glutaraldehyde-induced colitis: Case reports and literature review. Kaohsiung J Med Sci. 2011;27(12):577-580.
- Ahishali E, Uygur-Bayramiçli O, Dolapçioğlu C, et al. Chemical colitis due to glutaraldehyde: Case series and review of the literature. Dig Dis Sci. 2009;54(12):2541- 2545.
- Nienhiser J. How to protect yourself against cancer with food. Weston A. Price Foundation, Feb. 24, 2009. https://www.westonaprice.org/health-topics/modern-diseases/how-to-protect-yourself-against-cancer-with-food/.
- de’Angelis N, Di Saverio S, Chiara O, et al. 2017 WSES guidelines for the management of iatrogenic colonoscopy perforation. World J Emerg Surg. 2018;13:5.
- Miller K. This woman died after having a routine colonoscopy – now the hospital is being questioned. Yahoo!, Jan. 22, 2019.
- Mayo Clinic. Virtual colonoscopy. https://www.mayoclinic.org/tests-procedures/ virtual-colonoscopy/about/pac-20385156.
- U.S. Food and Drug Administration. What are the radiation risks from CT? Dec. 5, 2017. https://www.fda.gov/radiation-emitting-products/medical-x-ray-imaging/ what-are-radiation-risks-ct.
- Rabin RC. Colon and rectal cancers rising in young people. The New York Times, Feb. 28, 2017.
- Siegel RL, Fedewa SA, Anderson WF, et al. Colorectal cancer incidence patterns in the United States, 1974–2013. J Natl Cancer Inst. 2017;109(8):djw322.
- Clopton J. More young adults getting colorectal cancer, dying from it. WebMD, June 7, 2019.
- Katella K. Gen-Xers and millennials need to know. Yale Medicine, June 26, 2017. https://www.yalemedicine.org/news/colorectal-cancer-in-young-people.
- National Cancer Institute. Why is colorectal cancer rising rapidly among young adults? Nov. 5, 2020. https://www.cancer.gov/news-events/cancer-currents-blog/2020/colorectal-cancer-rising-younger-adults.
- Redwood L. The disturbing increase in colorectal cancer in young adults. Children’s Health Defense, Mar. 28, 2019. https://childrenshealthdefense.org/news/ the-disturbing-increase-in-colorectal-cancer-in-young-adults/.
- Redwood L. Glyphosate and colorectal cancer in young adults. Children’s Health Defense, Aug. 22, 2019. https://childrenshealthdefense.org/child-health-topics/ known-culprit/glyphosate-and-colorectal-cancer-in-young-adults/.
- Samsel A, Seneff S. Glyphosate, pathways to modern diseases II: Celiac sprue and gluten intolerance. Interdiscip Toxicol. 2013;6(4):159-184.
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