How Often do I Need a Colonoscopy?

When is my next colonoscopy due?  Patient's ask me this all the time.

While this inquiry would seem to lead to a straightforward response, it often doesn’t.  Why is this the case?  Isn’t there a simple chart instructing gastroenterologists when the next exam is due?   Yes, there are published guidelines, which were recently revised in 2019, but not everyone follows them.  Some physicians advise the same colonoscopy intervals that they have been recommending for many years.  Others rely upon their own judgement rather than consulting with professional guidelines.  More often than you might think, patients are the driving force such as when they request a colonoscopy sooner than is medically necessary.  I have heard many times patients relating vignettes such as ‘my friend was just diagnosed with colon cancer.  I know I’m not due until next year but can we schedule it now?’  And keep in mind that when any new medical guideline is issued, it takes time for practitioners to adjust to the changes, even though one might think that this transition should be seemless. 

The Medical Profession Moves Slowly

Sometimes, gastroenterologists like me just have to wing it when the relevant information is not available, not known or no longer obtainable. 

In an ideal world, this is what I need to know to give a precise and accurate recommendation on the timing of the next colonic intrusion.

• When exactly was your last colonoscopy?
• If polyps were removed, what type of polyps were they?
• How large were the polyps?
• If any close relatives had polyps, what types of polyps were they and what were the relatives’ ages when the polyps were discovered?
• If a close relative had colon cancer, what was the age at diagnosis?

I’ll let readers surmise how often patients have this information available.  I’ll give you a hint – almost never.  Quite often, they are not even certain if they had polyps or not.  “I think I had a polyp.  Maybe it was ‘piles’?  Not sure.”

Of course, it’s optimal if I have the patient’s prior colonoscopy report in front of me.  This permits me to verify that the exam was complete and the colon was spanking clean after the prep allowing for complete visualization.  If an area was not well seen, then this could justify performing the next exam sooner.

While I rely upon published guidelines, often I have to call an audible.  This is part of the job.  Every day doctors are trying to give our best advice when we don’t have all the data that we need. 

Editor’s Note: For 16 years, I've published weekly essays here on Blogspot, which will continue. I’ve now begun publishing my work on a new blogging platform, Substack, and I hope you’ll join me there. Please enter your email address at this link to receive my posts directly to your inbox. Let the dialogue begin! And thanks for reading!