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.
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!
Comments
Post a Comment