Withdrawal Time During Colonoscopy Test Should be More Than Six Minutes
Colonoscopy is almost always painless and most patients are asleep for the entire procedure. Taking laxatives and/or enemas before the test to clean out the colon isn't fun, but most people find this to be the worst part of the procedure. It may be embarrassing or awkward, but it is certainly better than having cancer.
Certain people may require colonoscopies before age 50. These include persons with a history of colon polyps or inflammatory bowel disease, and people with a first degree relative (mother, father, brother or sister) with colon cancer that developed before the age of 60.
Despite the relatively high number of cases and deaths, there's good news about colon cancer. Screening tests, along with a few simple changes in your diet and lifestyle, can dramatically reduce your overall risk of developing colon cancer.Additionally, patients with personal or family history of other types of cancer may need to consider colon cancer screening at an earlier age.
Indications for colonoscopy include gastrointestinal hemorrhage, unexplained changes in bowel habit or suspicion of malignancy. Colonoscopies are often used to diagnose colon cancer, but are also frequently used to diagnose inflammatory bowel disease. In older patients (sometimes even younger ones) an unexplained drop in hematocrit (one sign of anemia) is an indication to do a colonoscopy, usually along with an EGD (gastroscopy), even if no obvious blood has been seen in the stool (feces).
Fecal occult blood is a quick test which can be done to test for microscopic traces of blood in the stool. A positive test is almost always an indication to do a colonoscopy. In most cases the positive result is just due to hemorrhoids; however, it can also be due to polyps (which are easily removed during the colonoscopy procedure), diverticulosis, inflammatory bowel disease (Crohn's disease, ulcerative colitis), or colon cancer.
Approximately 50,000 people die of colon cancer every year. Yet, colon cancer can almost always be caught in its earliest and most curable stages by colonosocopy. Almost all men and women age 50 and older should have a colonoscopy.
Colonoscopy. This procedure is the most sensitive test for colon cancer, rectal cancer and polyps. Colonoscopy is similar to flexible sigmoidoscopy, but the instrument used — a colonoscope, which is a long, flexible and slender tube attached to a video camera and monitor — allows your doctor to view your entire colon and rectum. If any polyps are found during the exam, your doctor may remove them immediately or take tissue samples (biopsies) for analysis. This is done through the colonoscope and is painless. If you have adenomatous polyps, especially those larger than 5 millimeters in diameter, you'll need careful screening in the future.
Recently, a new study shows that doctors who perform colonoscopies for early detection of colorectal cancer get better results if they spend at least six minutes looking for abnormal growths.
The study recorded the experience of 12 experienced gastroenterologists who did 7,882 colonoscopies, 2,053 of them for patients who'd never had a colonoscopy. In 501 of those first-time -- or screening -- exams, the amount of time spent was less than six minutes.
Those exams were the least productive. In all, cancerous or precancerous growths were detected in 23.5 percent of those patients examined. But such growths were detected in only 11.8 percent of exams where the period of examination -- called withdrawal time -- was six minutes or less; growths were detected in 28.3 percent of exams with a withdrawal time of more than six minutes.
"We think our data suggest that if the goal of colonoscopy is to detect and remove polyps, spending slightly more time in the procedure seems to translate into a better outcome for patients," said study co-author Dr. Robert L. Barclay, a partner in Illinois-based Rockford Gastroenterology Associates.
"This basically reinforces and provides evidence for the quality recommendations that have already been made," said Dr. Durado Brooks, director of colorectal cancer for the American Cancer Society.
Withdrawal time is "a very important measure of the quality of colonoscopy," Brooks said, and the U.S. Multisociety Task Force on Colorectal Cancer has recommended a minimum withdrawal time of six minutes.
"This study clearly shows that six minutes is a critical point, and those patients who had less had a strikingly low rate of adenoma [growth] detection, and there is at least a suspicion that the cancer detection rates would be lower," he said.
Brooks applauded the report. "I'm not sure that there has been a study as well done as this one showing a marked difference between withdrawal rates less than six minutes and more than six minutes," he said.
Barclay said the members of his medical group decided to do the study because "we do a lot of screening in our practice, with an increasing volume causing us to spend a disproportionate amount of time on it, and we wanted to make sure we were doing a decent job."
The results of the study have led to a change in the way colonoscopy is done by the group, he said.
"We've reviewed these results, and they were so impressive that we now take an extended minimum amount of time," Barclay said. "We have measured detection rates for a withdrawal time of eight minutes, and we found that with that simple step, there was a dramatic increase in polyp detection among all our physicians."