Colonoscopy and Colon Cancer Screening
Why Perform Screening Colonoscopy
Screening for colon cancer with colonoscopy is recommended for most patients starting at age 50. Some patients at high risk may need and exam at an earlier age. Screening colonoscopy has resulted in a decrease in the incidence of colon cancer. Examples of patients at high risk are patients with a first degree relative with colon cancer at any age or two second degree relatives with colon cancer. There are additional diseases that may place you at increased risk. Colonoscopy offers the patient a test that can find pre-cancerous lesions but can also remove those lesions avoiding surgery and preventing the future development of colon cancer.
Colonoscopy is the visual examination of the large intestine (colon) using a lighted, flexible video endoscope. The procedure is performed as an outpatient test. Throughout the country the majority of these are performed in hospital outpatient department or ambulatory surgery centers (ASC). The physician’s at GA Endoscopy were trained in endoscopic techniques as part of their specialty training in gastroenterology.
Quality Measures for Colonoscopy
Quality indicators for colonoscopy have been developed and include documentation that the entire colon was examined (a picture of the appendix opening / small bowel - terminal ileum), withdrawal time (time spent looking at the colon, cecum to anus) and adenoma detection rate (ADR). Adenomatous polyps are a particular type of polyp that causes most colon cancers. Physicians performing screening exams should know their ADR. Currently in 2017 a minimum ADR of at least a 30% in men and 20% in women would indicate that high quality exams are being performed. Does your doctor know his / her ADR? GA Endoscopy participates in GIQuIC a "non-profit collaboration of the American College of Gastroenterology (ACG) and the American Society for Gastrointestinal Endoscopy (ASGE) as a quality benchmarking registry that is raising the bar on efficiency, effectiveness and reliability". The forms download section has additional information about colonoscopy, screening for colon cancer and when do I need to repeat my colonoscopy.
As a screening exam for colon cancer GA of Southeast Missouri offers the patient the option of preparing for their first colonoscopy at home without a prior office visit. The patient will meet with their physician at the time of the procedure at GA Endoscopy. This allows for one trip to the center. There are requirements that the patient must satisfy to allow this type of examination. Patients can call and speak to our staff to see if this is an option for them. Our staff will perform an interview with the patient and if the direct screening history qualifies the patient for this option a date can be set for your colonoscopy. Preparation instructions will be mailed to the patient and reviewed with the patient.
To obtain the full benefits of the exam, the colon must be clean and free of stool or waste. This CANNOT BE EMPHASIZED ENOUGH. The patient will receive instructions on how to do this. It involves drinking a solution (preferred) using a split dose technique (half of the medication is taken and the second half several hours later), which flushes the colon clear of debris. The patient will alter their diet a few days before the exam and on the day prior only clear liquids are consumed. The physician advises the patient regarding the use of regular medications during that time (procedure preps section for colon preps). A POOR PREPARATION can result in failure to see pre-cancerous polyps which could set the stage for cancer several years later. Poor preparation could increase the risk of a complication during the procedure. Poor preparation could result in a need to repeat the test in one year or less.
The patient is sedated (conscious sedation) in fact for most standard colonoscopy or upper endoscopy exams conscious sedation is adequate and avoids the added cost of an anesthesiologist. After sedation the endoscope is inserted through the anus and moved gently around the bends of the colon. If a polyp is encountered, a thin wire snare or forceps (pinching device) is used to remove the polyp. Electrocautery (electrical heat) may be applied to painlessly remove larger polyps and to control bleeding. Other tests can be performed during a colonoscopy, including biopsy to obtain a small tissue specimen for microscopic analysis.
Your sedation may take 10 minutes, and then the procedure 15 to 30 minutes. Times vary depending on the preparation of the colon and the findings during the test. The sedated patient seldom remembers this event. A recovery area is available to monitor your vital signs until the patient is fully awake. It is normal to experience mild cramping or abdominal pressure following the exam. This usually subsides in an hour or so.
After the exam, the physician explains the findings to the patient and family. Some patients may not recall the discharge conversation and family member or companion may take note of findings. Post procedure appointments may be made at this time. If a biopsy has been performed or a polyp removed, these results (pathology report) may take several days.
Bloating and distention may occur for about an hour after the exam until the air is expelled. Serious risks with colonoscopy, however, are very uncommon. One such risk is excessive bleeding, following the removal of a polyp. This may require a procedure to stop the bleeding. In rare instances, a tear in the lining of the colon can occur (a perforation). These complications may require hospitalization and rarely surgery. Despite careful performance of colonoscopy at intervals recommended by the physician colon cancer may still develop. This is known as an interval colon cancer and is rare. These tumors are either very aggressive fast growing lesion, a polyp in an area that was not well seen or very flat (carpet) polyps that can be missed with residual debris in the colon at the time of the exam.
Several factors play a role in determining when this procedure should be repeated. In a large portion of the population if a screening colonoscopy is performed at age 50 and no significant pathology is found, the colon is well prepared (stool and debris are not present), and no significant family history of colon cancer, then the test would be recommended at age 60 or ten year intervals.
Factors that influence when this test should be repeated (1, 2, 3, 5, or 7 years) in the future include but not limited to the following:
- pathology found (significant polyps, not all polyps are a precursor to colon cancer)
- history of colon cancer
- family history of colon cancer
- quality of the colonoscopy (did the patient prepare properly, is the anatomy well seen during the exam)
- chronic inflammatory bowel disease