Asking The Right Questions Might Lead To Better Colonoscopy

Main Category: Colorectal Cancer
Article Date: 30 Jan 2009 - 1:00 PDT

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Patients need to be informed and not just pick a doctor out of the phone book or off the Internet when considering getting a colonoscopy. Recent research has shown that an inexperienced doctor can lead to less than perfect outcomes.

"Patients need to ask a lot of questions before undergoing a colonoscopy," said Dr. Karen Woods, a gastroenterologist with The Methodist Hospital in Houston. "They need to know if the doctor is board certified in gastroenterology or colorectal surgery and a highly trained endoscopist, how many colonoscopies they have performed, how long they spend withdrawing the scope and looking for polyps and how often they get to the end of the colon."

Approximately 25 percent of men and 15 to 20 percent of women who undergo colonoscopies for their initial screening exam will have pre-cancerous polyps, so a physician's detection rate of polyps should be at least that or higher. A recent Canadian study found that the test missed almost every cancer in the right side of the colon and missed a third of cancers in the left side of the colon. However, approximately 70 percent of the procedures in this study were not done by a gastroenterologist, but instead by internists and family practitioners who might lack the experience to do the test properly. This is why it's important to make sure you find a physician who has a wealth of training and experience, she said.

"It's important for doctors to take their time and get all the way to the end of the colon on the right side," Woods said. "He or she should then take at least six or seven minutes, if not longer, on the way out carefully examining and searching for polyps. This amount of time will give them a better chance of finding polyps, including a so-called "flat" (hard to see) polyp, which is a flat lesion that can be hidden along the colon wall and sometimes missed by going too fast."

Woods and her colleagues at The Methodist Hospital are part of a joint project between the American Society for Gastrointestinal Endoscopy (ASGE) and the American College of Gastroenterology (ACG) that is looking at ways of improving quality in endoscopy. Doctors from multiple medical institutions throughout the United States submit their colonoscopy data, which is then analyzed. When the project is over, they hope to establish guidelines that will improve the polyp and cancer detection rate as well as improve the overall quality of the procedure.

"We tell people they should begin getting a colonoscopy at age 50," Woods said. "So if we are encouraging them to take care of themselves, it's up to us to make sure we come up with the proper guidelines to make sure the procedure is done properly every time."

Facts about colon cancer:

-- Colon cancer kills more than 50,000 a year and it's the second leading cause of cancer death for both men and women.

-- Although the disease is 90 percent preventable if detected early enough through a colonoscopy, only a little over 50 percent of people over age 50 undergo the procedure.

-- Symptoms include blood in the stool, changes in bowel habits and abdominal pain.

-- Many patients do not have symptoms until the cancer is more advanced, so it is important to undergo a screening colonoscopy even if there are no symptoms.

Methodist Hospital Houston
6565 Fannin St.
Houston
TX 77030
United States
http://www.methodisthealth.com

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