Do you know the right questions to ask when getting a screening colonoscopy? Do you know how to make sure you are getting high quality care?
"Most people focus on the dislike of the preparation, the need to arrange transportation and the fear of being anesthetized during the procedure and then potentially getting a cancer diagnosis," says Neil Gupta, MD, MPH, Director of Endoscopy at Loyola University Health System. "Screening colonoscopy is a very critical examination that really can determine life and death when it comes to colon cancer. It is now clear that not every colonoscopy is equal. Once you've decided it's time to get a screening colonoscopy, the next step is to make sure that you get a high-quality one."
Dr. Gupta has performed thousands of colonoscopies, has lectured and taught physicians around the world on endoscopy, and has published numerous studies on colonoscopy and quality in healthcare. He recommends that patients ask these four questions when planning a colonoscopy.
1 - What is the adenoma detection rate of the person who will be performing your screening colonoscopy?
"Adenomas are the pre-cancerous polyps that the practitioner identifies and removes during screening colonoscopy," says Dr. Gupta. Several studies over the past few years have shown that physicians who detect more adenomas during screening colonoscopies are conducting higher quality examinations. The patients of these physicians are less likely to get colon cancer and less likely to die from colon cancer.
Because of this research, multiple medical societies and the Centers of Medicare Services recommend that physicians who perform screening colonoscopy record and monitor their adenoma detection rate. Every physician who performs screening colonoscopy should know his/her adenoma detection rate. Dr. Gupta has an adenoma detection rate of more than 50 percent, meaning he has identified and removed pre-cancerous polyps in more than 50 percent of the screening colonoscopies he has performed in the recent past. "The higher your physician's adenoma detection rate, the less chance you have of developing colon cancer after your colonoscopy and the better quality care you have received. Every physician's adenoma detection rate will be different, but a adenoma detection rate of at least 20 percent is currently considered a minimum benchmark."
Just because a patient has a colonoscopy procedure or a polyp removed, doesn't mean a clean bill of health. "You want the all pre-cancerous polyps identified and removed as early as possible to prevent cancer development," says Dr. Gupta.
2 - Does your doctor use a split-dose bowel preparation?
"Studies show that taking half the prep solution the night before, and then the other half the day of the exam is the best way to clean the entire colon before a screening colonoscopy. This 'split-prep" method allows for optimal viewing of the lining of the colon and gives your physician the best chance at finding any pre-cancerous polyps that may be in your colon," says Dr. Gupta. "Traditionally, patients swallowed a gallon of solution methodically over a continuous period of time to clean out the system the night before the procedure. That method is not as effective."
Questions to ask after your colonoscopy
3 - Did I have a good quality bowel prep?
"There is a rating scale used by physicians to assess and document how clean the lining of the colon was during the colonoscopy. Generally, the rating is rated: poor, fair, good and excellent," says Dr. Sprang. Michael Sprang MD, assistant professor of medicine at Loyola University Chicago Stritch School of Medicine, is a gastroenterologist at Loyola University Medical Center and on staff in the Division of Gastroenterology with Dr. Gupta. "The better the rating, the better the conditions for a high-quality examination. If you receive a fair or poor rating, talk to your physician about whether you need to do the colonoscopy again or whether you should have your follow-up colonoscopy sooner than normal."
4 - Am I getting an appropriate recommendation for when to come back for my follow-up colonoscopy?
"Contrary to popular opinion, the removal of polyps does not mean you are in the clear for a longer time before your next colonoscopy," says Dr. Sprang. "If even one adenoma (pre-cancerous polyp) is identified, the patient is at greater risk of developing additional adenomas and should be screened more frequently."
Medical societies have created guidelines regarding how often patients should get follow up colonoscopies that depend on each patient's colonoscopy findings and medical history. The Centers for Medicare & Medicaid Services are currently collecting data from physicians regarding how often each physician follows these screening colonoscopy guidelines. In the future, this data may be available to the general public, but for now, patients should ask their physicians whether they are getting follow up examinations as per current guidelines. "Getting a high-quality colonoscopy is just the first step in receiving high-quality care," says Dr. Sprang. "Arranging the appropriate follow-up tests and care is equally important to protect and preserve your health."
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