Getting a Good Colonoscopy

It is easy to talk about preventing colorectal cancer through healthy lifestyle choices and screening. But discussing how to get a good colonoscopy is a more awkward subject. Most of us will start getting routine colonoscopies beginning at age 50 — an important tool in the fight against colorectal cancer. Yet, no one really wanted to discuss their personal colonoscopy experiences with me. Though, one co-worker did offer up that her encounter with a colonoscopy “really wasn’t that bad” and suggested drinking the bowel prep laxative cold versus room temperature.

Step 1
This leads me to the first step in getting a good colonoscopy: good colon prep. And with so many things in life, the first step may be the hardest. Prepping your colon usually involves dining on a special low-fiber diet and drinking what I’ll call a laxative punch (best served cold, according to the anonymous co-worker). A process that causes some “mild to moderate abdominal cramping” after partaking in the preparation and, more honestly, probably an unpleasant day spent in the bathroom.

“We know the prep required is a challenge, but a clean colon is essential for a good exam” says gastroenterologist Johannes Koch, MD, with VM’s Digestive Disease Institute. “If the colon isn’t properly prepped, the procedure can take longer, polyps and lesions may be missed, and the whole thing may need to be repeated sooner or even rescheduled.”

Step 2
Dr. Koch also told me that good preparation is just one part of the quality colonoscopy equation. After the patient completes a good bowel prep, the endoscopist must do their part. “The most important part of an optimal colonoscopy is a careful examination of the entire colon by the endoscopist. Patients should ask the provider about their performance on key quality metrics/outcomes,” he explained.

There are several measures of quality outcomes beyond low complication rates, but the adenoma detection rate is one that is commonly used and easy to understand. During a colonoscopy, the doctor pushes the endoscope to the top of the colon and slowly withdraws it, looking for adenomas (aka benign tumors or polyps). When an adenoma is found (detected), it is removed during the procedure. According to the American Cancer Society, removing polyps can help prevent colorectal cancer from ever starting. Adenoma detection rate refers to the percentage of time at least one polyp is found during all the colonoscopies performed by an individual doctor. When this rate falls below 20 percent, the risk of colorectal cancer diagnoses in their patients goes up. Therefore, you want to get a colonoscopy from a doctor whose adenoma detection rate is at least 20 percent.

Step 3
Of course your doctor’s adenoma detection rate loses much of its luster if you don’t receive timely pathology results from tissue samples taken during the procedure. Ask your physician how and when your results will be reported to you. You can also ask about the qualifications of the pathology team where your samples go for review and interpretation.

As with all preventive health screenings, the bottom line is that early detection saves lives, so be sure to do your part to help boost the process. Besides, no one should have to drink laxative punch without feeling assured that all significant polyps were removed.

Comments

  1. ColonoscopyQuestions says:

    “Therefore, you want to get a colonoscopy from a doctor whose adenoma detection rate is at least 20 percent.” How can I find that information? Is there some publicly accessible database or site where doctor’s detection rates are posted for comparison purposes? What are your suggestions for easily, efficiently, and economically discovering the information?
    “You can also ask about the qualifications of the pathology team where your samples go for review and interpretation.” How do I interpret the qualifications? Which quals should I ask about? Are there some standards I should use to compare the quals against? For example, some type of board certifications (from where?), years of experience, years with specific team, etc.?

    • VM Guest Blogger says:

      “How can I find that information? Is there some publicly accessible database or site where doctor’s detection rates are posted for comparison purposes? What are your suggestions for easily, efficiently, and economically discovering the information?”

      Great question. This information can be quite difficult to find as there are currently no requirements on reporting. Start by asking your primary care provider and the office of the gastroenterologist/colonoscopist performing the procedure if they can provide you with the information. Insurance carriers have not routinely collected or reported quality metrics, but calling to let them know you believe this is important would be a start. Some groups have published information about their own performance metrics. At Virginia Mason, we have a team in our Digestive Disease Institute dedicated to measuring numerous quality metrics so all of our endoscopists are aware of their adenoma detection rate. Our team has also published results of a study which included the ADR of VM endoscopists:

      The effect of periodic monitoring and feedback on screening colonoscopy withdrawal times, polyp detection rates, and patient satisfaction scores
      http://www.sciencedirect.com/science/article/pii/S0016510710000301
      Original Research Article, Pages 1253-1259
      Otto S. Lin, Richard A. Kozarek, Andrew Arai, Michael Gluck, Geoffrey C. Jiranek, Kris V. Kowdley, Susan E. McCormick, Drew B. Schembre, Maw-Soan Soon, Jason A. Dominitz

      “How do I interpret the qualifications? Which quals should I ask about? Are there some standards I should use to compare the quals against? For example, some type of board certifications (from where?), years of experience, years with specific team, etc.?”

      The most reliable indicator for pathologists will likely be the length of the relationship they have with the endoscopist(s). Pathologists have board certification and are judged best by the clinicians providing them patient specimens. Look for an established pathology group with a solid track record as reflected by their relationship with your endoscopist.

      — Johannes Koch, MD
      Digestive Disease Institute
      Virginia Mason Medical Center

  2. ColonoscopyQuestions says:

    Dr. Koch – Thank you for the thoughtful reply. I was going to write that it will take me some time to digest it…. 🙂 The link to the study didn’t work for me, but I performed an online search and also found the paper here: http://www.ncbi.nlm.nih.gov/pubmed/20598251

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