Colonoscopy – Questions to Ask GI Doctor | Arshad Malik, MD

According to the American Cancer Society, colon cancer is the third leading cause of cancer-related deaths in the U.S. and is expected to cause close to 50,000 deaths in 2016.  As a gastroenterologist in Plano, TX promoting the awareness and prevention of colon cancer is very important to my practice.  The gold standard procedure used to screen for colon cancer is colonoscopy.  This is due to being able to both screen and remove polyps in the colon during the same procedure.  However, since colonoscopy has a rather negative public perception I wanted to take an opportunity to provide some important information on this potentially life-saving procedure along with questions to discuss with your gastroenterologist regarding colonoscopy. 

When Should I Get a Colonoscopy?

The American College of Gastroenterology (AGA) recommended guidelines for colon cancer screening should begin at age 50 for most people. However, factors such as ethnicity and family history could result in starting this screening at an earlier age. It’s important to discuss this with your doctor and follow their recommendations on when to start this screening. 

How Can I Be Sure that My Gastroenterologist will do a Careful Examination?

While several types of doctors do perform colonoscopy, studies have shown that gastroenterologists have better results in detecting colon cancer. The AGA recognizes that when selecting a gastroenterologist there are 2 quality indicators that provide the best assessment of a physician’s skills and thoroughness during a colonoscopy – adenoma detection rate and the cecal withdrawal time. 

The adenoma detection rate is the percentage of time that adenomatous or “precancerous” polyps are detected in asymptomatic individuals. Finding this type of polyp is the main objective of colonoscopy and decreases the incidence of colon cancer. The current goal for each provider as outlined by the American Society of Gastrointestinal Endoscopy is an adenoma detection rate > 25%. In 2015, Dr. Malik’s adenoma detection rate was 37% (females) and 39% (males).

The cecal withdrawal time is the duration it takes for the gastroenterologist to withdraw the scope after they have already advanced the scope to the beginning of the colon. The accepted minimum withdrawal time in the U.S. is 6 minutes. In 2015, Dr. Malik’s cecal withdrawal time was 8.3 minutes

While these indicators are not currently available to the public, patients should feel free to ask their gastroenterologists their adenoma detection rate and average cecal withdrawal time when evaluating which doctor is best for them. 

Why is Effective Bowel Preparation Important for Colonoscopy?

Bowel preparation for colonoscopy refers to the laxatives taken before the procedure to clean the colon of fecal debris. The less debris in the colon allows your gastroenterologist the best opportunity to identify a polyp or even a small cancer.

I’ll acknowledge that this is the most unpleasant part of the exam process, but also the most important! I’ve created a short video for patients that reinforces the importance of the prep along with a with a few tips to make it more pleasant – If you have questions about the prep, I encourage you to discuss them with your doctor in advance of the colonoscopy. 

Are there certain medications I should stop taking before colonoscopy?

Yes. Most gastroenterologists recommend to stop taking any aspirin or ibuprofen products. Also, stop taking blood thinners 3-5 days prior to colonoscopy. If you regularly take either of these, you’ll want to discuss with your gastroenterologist prior to the colonoscopy. 

If I undergo sedation, should it be given by an anesthesiologist?

Most gastroenterologists work with nurse anesthetists to deliver sedation for the procedure. This is done since there is virtually no evidence that the procedure is any safer when an anesthesiologist is involved, and using an anesthesiologist for a routine procedure like colonoscopy, if you are healthy, is not a cost-effective medical practice.

If you have questions regarding the anesthesia used during colonoscopy, I recommend that you discuss with your doctor prior to the procedure so that they can address any concerns that you may have and make sure that you are as comfortable as possible during the colonoscopy. 

Is the Colonoscopy Painful?

Since patients are under anesthesia during colonoscopy, there is no pain or discomfort. 

How will I feel after Colonoscopy?

Most people feel fine after a colonoscopy, although it is perfectly normal to feel a little woozy from the anesthesia. Nurses will observe you as you awaken after colonoscopy and make sure that you are doing ok. Due to the anesthesia, all patients must have a ride home after the procedure and should not return to work that day.

What Happens if the doctor finds a polyp in my colon?

The purpose of a colonoscopy is to look for polyps and to remove them before they turn into cancer. Once a polyp is found several different methods can be used to remove it depending on the size and location of the polyp. As far as safely possible all polyp tissue is removed at the same time during the colonoscopy. 

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