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Choose Well – Who Will Do Your Colonoscopy?

Dr. William Semon
March 2010
Revised February 2011

March is Colon Cancer Awareness Month and I thought that I would take this opportunity to share my thoughts regarding colonoscopy. I thought that I would begin by sharing with you the details of my daughter's visit home for winter break. My daughter lives in Minneapolis and drives home to Des Moines every few weeks. Her 10 year old car with 130,000 miles on it just wasn't reliable. So, we started our car buying experience by doing our homework. We looked at price, reliability, resale, and automobile dealers and their service departments. Having investigated these points, then, and only then, did we go out to test drive the car. I think that we put much thought into the car buying process. Funny thing though, I wonder if most of my patients or their family physicians put as much time in deciding on who will do their screening colonoscopy as we did on buying the car.

What is very clear to me is that we have an abundance of physicians in this community who perform screening colonoscopies. But, are they all the same or, like cars, are they different? If I were to choose a provider to perform a screening colonoscopy, I think that I would ask myself the following questions:

1. Did the physician go through a formal dedicated training program that emphasizes how to perform the procedure in a safe manner?
2. Did the program teach them how to interpret mucosal detail, but more importantly, did the program teach how to interpret these findings in light of the patient's symptoms?
3. Does the physician have an understanding of gastrointestinal disease pathophysiology and has he or she developed appropriate skills to manage the patient following the exam? Is he or she Board Certified?
4. If a procedure is performed on a patient with symptoms and no abnormalities are detected on their colonoscopy, is the patient advised to see another physician to manage these issues.

Once you think you've found the physician who you want to use or who your family doctor recommends, ask yourself the following questions:

1. Are they able to inspect the entire colon greater than 95% of the time or are the colonoscopies incomplete necessitating the need for an X-ray?
2. What is the miss rate for colon cancer with your physician? In the hands of a trained gastroenterologist, it should be less than 3%, but it is 13% for non-gastroenterologists.
3. Are patients being sent for surgical resection unnecessarily? Polyps less than 2 cm. should seldom be removed by surgical resection. Experienced gastroenterologists routinely remove polyps greater that 2 cm. depending upon location and accessibility.
4. What is the perforation rate of the physician that I am using? The perforation rate for a screening colonoscopy is less than 1 in 1,000 colonoscopies.
5. Is my physician following national guidelines with regard to the frequency of follow-up colonoscopies? Patients with a single small adenoma (less than 1 cm. in size) should have a follow-up colonoscopy in 5 years. Patients with no family history of colon cancer or adenomatous (pre-cancerous) polyps who are found to have a hyperplastic (non-cancerous or benign) polyp in the sigmoid or rectum should have a follow-up procedure in 10 years.

If the physician that you use is properly trained and following these general guidelines, then you have chosen well. If not, perhaps it is time to rethink this decision.

I hope that you found this information of value to you. Should you have any questions regarding its content, please feel free to contact me or one of my colleagues.

Dr. William Semon is a practicing gastroenterologist and hepatologist with the Iowa Digestive Disease Center and the Iowa Endoscopy Center since 1987.

Links to Additional Information on this topic:

1. Colon Ca Rates Lower After Specialist Screening
   (you must register to view this article on-line)
2. Endoscopist Specialty Is Associated With Incident Colorectal Cancer After a Negative Colonoscopy.