What’s a good colonoscopy? Part II
In her recent blog post Ms. Bebinger poses several excellent questions, and we are answering them.
Here’s our perspective on questions about quality measures:
“What’s the doctor’s detection rate? One medical society (the American Society for Gastrointestinal Endoscopy) says a doctor should find a polyp in 25% of men and 15% of women (why the difference?), but I know that some physician groups around Boston say the average is 40-50% among docs who really look for polyps.”
- The expectation is higher for men because they tend to form more adenomas, the pre-cancerous polyps that are of most concern, but there’s no clear answer for why there is a difference. The guidelines of 25% for men and 15% for women are minimums, and most experienced physicians will find adenomas in many more patients. Bottom line (pun intended): more studies need to be performed specifically looking at gender differences to better understand the colorectal cancer disease process.
- Next let’s briefly discuss why polyps get missed. The colon is not a straight smooth tube. It’s 6 feet long and must bend in many places to fit in the abdomen. Also, there are many folds in the wall of the colon that make it nearly impossible to view the entire lining with a colonoscope, which can look in only one direction – straight out of its tip. A pre-cancerous adenoma has no moral obligation to grow in an easy-to-see location – they often hide behind folds and turns. In fact, standard colonoscopy misses about 24% of adenomas, and 2/3 of those missed adenomas are hidden behind folds.
- The Third Eye Retroscope is a device that can provide doctors with a second, “backward” view that allows them to see more of the polyps behind folds and turns. Third Eye colonoscopy studies indicate an increased adenoma detection rate of 23% in standard patient populations; however the adenoma detection rate increased to 40% for patients at above average risk of colorectal cancer. To read more about your risk profile for colorectal cancer read: “When Being Average is Just Fine Thanks.” To learn more about the importance of your screening test read High Stakes: Your First Colonoscopy.
“How much time does the doctor spend, on average, on the test? I think more is better, is that right?”
- Physicians who rush through the exam too quickly are much more likely to miss adenomas, and most experts recommend spending at least 6-10 minutes observing the lining of the colon during withdrawal of the colonoscope. However, the duration of the exam is actually less important the quality of the examination technique. Conscientious physicians will spend much of that time flattening folds with the tip of the colonoscope in an attempt to see behind folds. Growing numbers of physicians are using a Third Eye Retroscope so they can get a more complete view of the areas behind those folds.
“Does the doctor always get to the end of the colon? OK, I may not be able to ask this. One website says I should ask the doctor to take a picture so that I know they got to the end – but this is too gross and how would I know what to look for anyway?”
- Another anatomy lesson will provide all the confidence you need to understand the pictures doctors will show you to prove they got to the end of the road (technically the start of your colon, called the “cecum”). There are two major landmarks that help to identify the cecum. One is the ileocecal valve, where the small intestine empties into the colon. The other landmark is the appendiceal orifice – a small dimple where the appendix attaches to the cecum. Colonoscopists’ success rates for reaching the cecum should be in the high 90% range, and they should be really proud to tell you this number. It’s their version of putting a flag on Mount Everest.
“Shopping for a colonoscopy could take weeks – not including the procrastination factor.”
We urge you to get through this task. Once scheduled, there’s even an app to help you get through the bowel prep process: “Colonoscopy Prep Assistant”—it’s available for the iPhone and Android platforms.
Readers, followers, fans, etc. are also welcome to let us know when you complete your colonoscopy (via blog comment or Contact Us form)—we will send you a Good For You certificate of achievement also!
Debbie Donovan is in the marketing department and is editor of this blog. Part of each day is also spent sharing the myriad of things said about bowel prep, colonoscopy and colorectal cancer on the Third Eye social media channels. Deb ice skates and likes routines with fancy footwork and spins.
Jack Higgins, MD is our Chief Medical Officer and is a clinical contributor to this blog. Dr Jack, (as we like to call him) spent 25 years as a Family Practice physician and was clinical faculty at Stanford University and University of California, Davis. He’s an avid cyclist and regularly rides many of the famous trails in the Northern California coastal area.<<more>>
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