Colonoscopy is important for patient more than 50 years old and those with symptoms such as blood in the stools, change on bowel habit, persistent diarrhoea and constant abdominal bloating or cramping. However, it is not easy to decide where and which doctor you should choose to perform the colonoscopy for you. While colon cancer screening services are available in many centres in Singapore, it is important to recognize what is a good colonoscopy.
Knowing that you have an experienced doctor with a wonderful track record can give you more confidence and help to allay your fears. Talking to your doctor and making sure you know what to expect can also go a long way in preparing yourself mentally for the procedure.
To make your colonoscopy experience as comfortable and worry-free as possible, here are some questions you should definitely ask your doctor before the colonoscopy:
- What is the doctor adenoma detection rate?
ADR is defined as the proportion of patients with at least one adenomatous polyp detected out of all the first-time colonoscopy patients over 50 years old that are screened by the doctor in a given time period. This is a strong indicator of quality of colonoscopy. In US studies. endoscopy doctors who tracks their doctor colonoscopy ADR records shows improvement in their detection rate compared to those without.
A lower ADR may mean a higher chance of missed polyps or cancers, while higher ADRs are an indication of effective colonoscopy.
A general guideline for a accepted ADR is 20% or higher for women patients, and 30% or higher for men. Unfortunately, not all doctor tracks their ADR because it involved audit of their endoscopy records, which can be sensitive as it involves patient data. Thus only doctors who track their ADR knows their own ADR records.
- What is their average withdrawal time like?
Withdrawal time defined by the time spent to examine the colon during withdrawal of the scope. This is a indicator of time spent to examine the colon as a short withdrawal time lead to increase risk of missed polyps or lesions.
Experts recommend looking for a doctor with a withdrawal time of more than 6 minutes.
- What is their cecal intubation rate?
Cecal intubation rate reflects the percentage of complete colonoscopy as caecum is the beginning of the large intestine while rectum is the end of colon. Some centre even recommends to include picture of terminal ileum as the true indicator of completion as sometimes poor quality photos cannot differentiate anatomy of colon.
The accepted intubation rate is 90% and above, means there is a 1/10 chance of incomplete scopes due to technical or anatomical issues. You would like to speak to you doctor incase of incomplete colonoscopy what should be done. It’s best to find a doctor with very low failure rate to avoid this situation.
- What is the preparation process like?
It is crucial to have complete bowel preparation as poor bowel clearing will affect the quality of colonoscopy, this includes increase risk of failed colonoscopy, missed polyps, missed cancer and even increase risk of colon perforation due to poor visualization.
Different doctors may have slightly different instructions and colon-clearing solutions for their patients. So, make sure you hear it from your doctor on the right steps to follow, complete the bowel preparation formula and don’t take short cut. Just remember, a colonoscopy can save your life and money because a poorly prepared bowel may leads to the need to repeat scope.
- What are the risks of colonoscopy?
Generally, the risk of colonoscopy divides into risk of moderate sedation and risk of the procedure itself.
The risk of sedation generally includes less than 1/10000 chance of heart attack, stroke, breathing difficulty requiring intubation and breathing support and even brain dead. This risk is higher in those with risk factors such as previous heart attack, heart failure, chronic lung disease, asthma, sleep apnoea, obese and overweight patient. In such circumstances, the procedure may be done with anaesthetist support and monitoring that may require additional cost on top of the colonoscopy. Otherwise, most endoscopists are accredited to give sedation themselves.
For colonoscopy, the general risk from are less than 0.1% perforation, 1-2% risk of bleeding, particularly if a polyp was being removed during colonoscopy. In the event of perforation, a surgery and hospitalization may be required to fix the perforation. It is important that the risk of bleeding for polyps removal may increase with the size of the polyps, some may carries risk of bleeding up to 5%, especially those polyps size more than 2cm with certain high risk features. It is best to discuss with your doctor during the consent taking to ensure you truly understand all the risks and benefits involved.
If you have persistent gastrointestinal symptoms or a high risk of colon cancer, it might be time to set a colonoscopy appointment with your doctor.