Colonoscopic Withdrawal Times and Adenoma Detection during Screening Colonoscopy
Posted on 12/15/2006 10:45:26 PM PST by neverdem
For years, patients and many doctors assumed that a colonoscopy was a colonoscopy. Patients who had one seldom questioned how well it was done. The expectation was that the doctor conducting the exam would find and cut out any polyps, which are the source of most colon cancer.
But a new study, published today in The New England Journal of Medicine, provides a graphic illustration of how wrong that assumption can be, gastroenterologists say. The study, of 12 highly experienced board-certified gastroenterologists in private practice, found some were 10 times better than others at finding adenomas, the polyps that can turn into cancer.
One factor distinguishing the physicians who found many adenomas from those who found few was the amount of time spent examining the colon, according to the study, in which the gastroenterologists kept track of the time for each exam and how many polyps they found.
They discovered that those who slowed down and took their time found more polyps.
“We were all experienced colonoscopists,” said Dr. Robert L. Barclay, a member of the group that participated in the study, Rockford Gastroenterology Associates in Rockford, Ill. “We had each done 3,000 or more colonoscopies before the study.”
Yet, Dr. Barclay added, “if our group is representative of an average group, you will see people who take 2 or 3 minutes and people who take 20 minutes” to examine a colon. Insurers pay doctors the same no matter how much time they spend. Gastroenterologists say colonoscopies can help prevent colon cancer, but warn that there is a pressing need for better quality control.
Still, the experts say, the onus remains on patients to ask for data on how proficient their doctors are.
“Patients assume that one colonoscopist is as good as another,” said Dr. Douglas K. Rex, a gastroenterologist...
(Excerpt) Read more at nytimes.com ...
"Yet, Dr. Barclay added, “if our group is representative of an average group, you will see people who take 2 or 3 minutes and people who take 20 minutes” to examine a colon."
I refused the drugs, and I'm pretty sure they were in there for hours,at least it seemed that way.
This slays me. "First, we kill all the gastroenterologists."
This slays me. "First, we kill all the gastroenterologists."
I know this will sound sick -- but I found my recent colonoscopy an interesting and reassuring experience..
Last year, I was scheduled for a mini colonoscopy, which is where a quick look is taken at a limited length of the colon without any anesthesia. A number of polyps were found and removed for examination.. None were malignant, but it raised my Doctor's suspicion.
So he order a full colonoscopy, which required anesthesia and about 10/15 minutes of "probe" time. Another few polyps were found and removed for examination.. Good news, nothing to be concerned about..
NOW - the interesting thing about both procedures is that the patient is provided a video monitor to watch and see exactly what is going on. The capability of the "probe" was amazing -- Clear video, well lighted - pumps air to "inflate" the colon to see into all the crevices, the ability to excise a polyp and cauterize the wound. The Doctor kept up a running dialog of what we were seeing and why is was so.
Folks should NOT avoid having the procedures - especially those over 55 or 60.. I've already lost a couple of seemingly healthy friends to colon cancer that was not caught in time to prevent death.
Believe me -- the WORSE part of the test is drinking that damned gallon of laxative to flush the system the evening before the test... The test was a piece of cake, and reassuring to get good news.
Semper Fi
Well, this is built on the unspoken assumption that one derriere is as good [or as big] as another. But it is a matter of common knowledge that some are really big derrieres while the others are much smaller. Now, the same logic ought to apply to colons.
Oh, by the way -- I should have mentioned...
Here in the San Francisco Bay area - Males need to keep a sharp eye on the Doctor and staff whenever we have our ass or family jewels exposed..
Most especially if you're expecting something to be "inserted".
</humor> but not much.
Semper Fi
Gives meaning to your tag line for sure.
Can we file this under "No sh**, Sherlock"?
L
Excellent.... and yes -- I guess it would work both ways.
Semper Fi
Trust me -- after that gallon of laxative -- the tubes are pristine!
Pretty and Pink, just like Hillary in her pink pant suit.
Semper Fi
Were you watching it during the proceedure or on a video replay later? If you could take this live, I have gained even more respect for your "Semper Fi". Wow.
Anyone ever hear of a twisted colon as a result of having
a colonoscopy?
Personally I'm still dealing with the shock of the annual prostate exam. The first time I told my doctor I usually made somebody buy me dinner and a couple of drinks first.
And if one more punk kid doctor says "Well at your age..." to me things are going to get ugly.
L
"I am 19, and have never had one of these exams before. Oy..."
You had better hope that by the year 2037 they don't have to shove cameras up your ass as they do now, but then again, by then it may be the law.
Remember, vote Republican.
Eighteen posts on this thread and no Katie Couric jokes yet?
Isn't she covered in #6, albeit indirectly? Besides, the late Khrushchev was affectionately known as "a-hole with ears". You could probably apply that one to her as well.
Just enjoy the hell out of your next 30 or 35 years! Your time will come.
That's funny.
Um, I am a gastroenterologist.
Any endoscopy nurse can tell you who consistently gives a good exam and who doesn't. One guy will line up 15 patients and be done in about 3 hours. He can't find squat but he lives in a very nice house. Another fellow routinely "dry-labs": says he's looked at the entire colon when he hasn't. Again, it's a cash issue.
My advise: if you can, ask an endoscopy nurse for your colonoscopy referal, not your doctor. Caveat derriere.
I was watching it REAL TIME -- as it was being performed, for both procedures. It a show one shouldn't miss.
I had heard all the horror stories of guys after their procedures -- swearing they would never do it again.. But after having experienced it myself - they had to have been real sissies or had an extremely low tolerance for pain. They too had the anesthesia - and still claimed pain.
Personally, I believe they worried themselves into pain by the expectation of pain. Focus on what's going on and learn from the experience..
That being said -- even MORE interesting but involving more anxiety - was watching my own angioplasty while the Doctor was searching for the cause of my heart attack and the damage it did to my heart. That is a a procedure where they insert the camera probe into an artery in your groin -- and then you have to turn, twist, raise arms, lean from side to side to assist the doctor in getting the camera where he wants it.. That damned procedure took more than an hour and I was exhausted at the conclusion -- but alive. At least I learned that my problem would not require a stent, surgery, pace maker or anything more that a change of life style, diet and more exercise.
The spookiest part was when the Doctor asked me to sign a release stating that I was informed that 1% of patients DIE from the damned procedure.. I asked him how he was doing with the odds and he just smiled -- that was reassuring. He also said a much larger percentage die after they refuse to sign the release authorizing the procedure... THAT was the selling point.
Semper Fi
Punk Doctors and Insults....
Yep, they do step in it from time to time....
Until they get to know you, and learn why your body looks such a mess.
The Doctor I have now is quite young - I WANT young doctors, and according to my wife -- he's a "heart breaking gorgeous" young Scotsman. Uh, She changed Doctors and transferred to mine... I need to keep an eye on that situation.
Semper Fi
Make up your mind :-)
... I had one recently, at age 57. The doctor told me afterwards that he had removed one polyp, and that I should have another exam in 10 years.
Then, I got a card in the mail with various categories checked off, indicating that this polyp was "pre-cancerous" and that I should have an exam in FIVE years. So, did a biopsy reveal something the doctor didn't know? or what? I tried calling back, but I hit an automated answering barrier, so I figured I have five years to think about it. I tried to impress the five-year date in my mind, but I forget it already. ... OK sixty two! "... if man is still alive ..."
L
Perhaps the Doctor spoke to you before receiving the lab analysis of the polyp.. Also, "pre-cancer" is not the RED flag.....just YELLOW the way it was explained to me.
My test went "clear" -- yet they told me to return in 5 years..
I suspect the good Doctor likes to replace his Mercedes on a 5 year plan -- no longer the 10 year plan.
Semper Fi
Heh. Heh. "Onus". He said "onus". Heh, Heh.
Oh, wait...
If you had a polyp removed with some pathologically confirmed dysplastic tissue, consider yourself fortunate; if it were me I'd consider a visit in three years. Remember that you are just a patient number in their system, a statistic as it were, and since you have this risk (as I probably do as well, genetically) it's up to you to be proactive.
Sorry for the lecture, I just remember how my granfather went, with the disease in his liver and stomach because they didn't do these back then.
Since you mention your occupation, is corruption really that rampant in the medical fields? I'm an avid reader of medical literature (esp. oncology and oncogenesis) and most seem very "into" their work. Perhaps that's because the doctors writing these papers/giving these seminars are more involved on the research side...?
I would not wait five years.
LOL
The last time I had one, the drugs administered were valium (to relax you) and demerol (to amuse you). They say that demerol is a "pain killer." To this day, I'm convinced that it doesn't stop you from feeling the pain. However, when you've had the demerol, you just don't give a damn! It seems that the drugs given are to done that way to keep you semi-concious, so you are able to help them by moving when they need you to move or shift positions.
Mark
My Dad, who is 80, always prefaces physical exams with a stipulation that his prostate is swollen...
Well this is going to depress Dad!
He used to get me to drop him off and pick him up after one of these "procedures"...
For him to retain and maintain his flight status...NASA made him get these once a year...
Somebody must be rolling around now that the joke is out...;-)
At least she's smiling...She must like it...
Ohhhh, I am sooooo going to get lectured on this one...
My doc said if you don't smoke and you are male, colon cancer is the number one killer...and there are no symptoms of colon cancer.
I'm not sure about his claim that it is above heart problems, etc.
"Believe me -- the WORSE part of the test is drinking that damned gallon of laxative to flush the system the evening before the test... The test was a piece of cake, and reassuring to get good news."
You might want to talk to your doctor. There are alternatives to drinking a gallon of laxative. I've had three of these things, I know.
The first one was three years ago. The doctor found a few polyps. He told me later that he didn't have time to remove them so I'd have to come back for a second a couple of weeks later.
Three years later, I had to have another. I insisted on another doctor. This one offered me three alternatives for the prep. I could drink the gallon. I could take two pills and drink two four oz. laxatives. Or, I could take a bunch of pills. I choose the combination. Much better. Found more polyps so I'll have to redo in three years.
Still, I wonder if the first doctor who didn't have time during the first procedure is the kind who only spends a few minutes. Evidently, there is a chance that the second doctor is much more thorough since he obviously doesn't stack his appointments so tightly.
"Um, I am a gastroenterologist. "
Love your screen name!!!
wow, you can refuse the drugs? Was it painful?
Now you tell me.
The doc who scoped me in August found a polyp but now I'll always wonder if it was just for show--you know, an obigatory snip to "prove" he had been thorough when in fact, he had not been.
On the other hand, he was an older guy in his late 50s or early 60s and he had me on the table for about 20 minutes. I figure if he's been river-running that long he ought to be able to spot the bad boulders more exactly and faster than a less experienced doc. But that's a weak inference, I realize.
My understanding is that it takes awhile for a benign polyp to become cancerous and that by the time they do, it's very obvious. In other words, if I'm going back to be scoped once a year (which is the plan now) the doc ought to be able to spot any bad stuff well before it gets too bad even if he's missing some tiny polyps with each scoping.
In any event, I'm glad I had the procedure done. It was only slightly annoying and not at all painful.
Thanks for the tip...I'll ask..
Perhaps we should warn folks - the laxative they prescribe for these procedures has a warning label: DO NOT LEAVE HOME DIRECTLY AFTER CONSUMING THIS LAXATIVE.
They MEAN it folks....There will be 10 second warnings - MULTIPLE times to get to your porcelain throne... NO MORE time than that.
Semper Fi
Germ Outbreak Reported at L.A. Hospital (Closed neonatal and pediatrics ICUs)
Prayer Requested for 68-69TonkinGulfYachtClub (Update at #2841)
Say a prayer for Tonk and his family.
FReepmail me if you want on or off my health and science ping list.
"wow, you can refuse the drugs? Was it painful?"
Refusing the drugs seemed to anger the doctors at the VA and yes it was painful, but I had to drive myself home and didn't want to be sedated, plus I think I have a little problem with giving up too much control.
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