Quality Colonoscopy Exam: Best Strategy For Detecting Polyps, Cancers
Publication of a Canadian study on colonoscopy's impact on reducing colon cancer deaths suggests a lower impact on mortality than previously reported. Physician experts from the American College of Gastroenterology urge patients and the public to recognize that even if the assumptions and design of this case-control study have produced accurate data, colonoscopy remains the best available option for detection of precancerous colon polyps and the only test with the potential to prevent colorectal cancer by removing these growths.
"While colonoscopy is not perfect, the physicians at the American College of Gastroenterology are committed to making a good test even better and patients can take steps to maximize the colonoscopy's potential," said Dr. Eamonn Quigley, ACG President.
"The position of the College is that the training and experience of the endoscopist are critical to a quality colonoscopy," he continued. The College advises patients to seek a well-trained endoscopist who performs many of these tests and has a record of performing a complete examination of the colon.
Gastroenterologists receive special training in colonoscopy and perform more colonoscopies by far than any other specialty. Their training emphasizes attention to detail and incorporates comprehensive knowledge of the entire GI tract to provide the highest quality endoscopy and consultative services. Many GI physicians participate in rating and improvement programs such as the one being piloted by the American College of Gastroenterology and the American Society for Gastrointestinal Endoscopy. Such a quality benchmarking program permits gastroenterologists to measure their performance on issues such as reaching the cecum, an anatomical landmark in the colon that represents a thorough exam.
"Beyond the training of the endoscopist, the most important take-away for patients from this study is the essential message of following the instructions on bowel cleansing -- the cleanest colon results in the best exam," added Dr. Quigley.
Following doctor's instructions when preparing for the exam is critical. Before a colonoscopy, the colon must be completely clean for the test results to be accurate. The ACG will soon publish a new guideline on colorectal cancer screening that will call for "split preps" -- a regimen for taking the laxatives in two doses that provides the cleanest colon at the time of the exam.
"The College sees significant strengths in the proven benefits of visualizing pre-cancerous growths and removing them in a single examination during colonoscopy," commented Dr. Quigley. "Because of its excellent sensitivity in detecting polyps and its potential for removing them and breaking the sequence of polyp to cancer in a single diagnostic and therapeutic intervention, colonoscopy is one of the most powerful preventive tools in clinical medicine."