"Annual" colonoscopy ???

I saw my GP for my "Annual Exam" this week. Thanked him for renewing my Sulfasalazine script.

Then I got another vmail from the new GI that wanted me on biologics.

I called back for the annual exam, but they said it was for my "Annual Colonoscopy"

Who does that every year ?

I know you do that after a decade with the disease, but I don't think it's need prior to that unless you're flaring all the time (I'm only assuming that).


Are you flaring? Is that why the GI said you need to be on biologics?

I think each case and Dr is different when it comes to them wanting colonoscopies done...I was a tough case so they always wanted me to do one annually but that wasn't my thing cuz in the beginning they scoped me so many times in the first couple of years that I thought it was over-kill so I have gone many yrs through out my over 2 decades, not having scopes done...now that I'm on Humira I'm sure I'll have to abide by my GI's requests for them.

I don't go for a yearly, but I did go from every 3 years to every 2 years.
I'll be seeing a new GI in spring after mine of almost 26 years will be retiring. I'll be due for one next year with him. I hope he won't be pushing the annual scope :-/
q

Wow - Taking it all in.

Thanks for the feedback. Feels a little soon to do that drill again but maybe given the Tony Snow history I should not go more than two years.

www.wellnessresources.com/health/articles/how_fiber_and_niacin_protect_against_colon_inflammation_and_cancer/

So back to Niacin and Psyllium seed powder ( Butyrate ) to prevent colon cancer.

What I cannot find is the mega-dose mg required. I recall taking too much once and the flush is awful.

15 minutes googling around I never saw how much is required for the benefit.

My G.I. said that I'll need one every year after it's been 20 years since my first diagnosis.

I'm a very cautious person so I won't mind doing them every year. But there are (minor) risks to be considered.

My GI always wants to do a scope but I say not so soon and she has no problem with that. Every time you get a scope you are at risk of infection etc. My doctor also agrees with this. Just a FYI I am in remission so probably would not refuse if I had active disease.

Current guidelines are every year after 10 years of disease, due to the increased cancer risk (some gastros will let you go two). I have had two IBD'er friends who were recently diagnosed with cancer...one after 8 years of pancolitis (she had a colectomy and is undergoing chemo), the others was discovered after surgery to remove a stricture (small bowel cancer - clear margins, but she's also undergoing chemo). Both are younger than I am (I'm 38). I am now on the every year schedule, but I have a history of perforation and have been unable to get the full screen done since I was perfed in 2010 (too much to get into, but I've got a delicate colonic mucosa, yay). My gastro is talking preemptive colectomy if I go too long without screening (I am hoping that Entyvio gets me into remission - if so, first thing I'm doing is scheduling a scope).

Yes, I will be the first ever Crohn's patient to push for a scope, and I know the risks from experience. It's hard to balance cancer screening/disease surveillance and the risks of the procedure (perforation, infection, triggering of a flare-up, etc).

American Cancer Society Guidelines are:



Risk Category: HIGH RISK
Inflammatory bowel disease:
-Chronic ulcerative colitis
-Crohn's disease


Age to Begin
Cancer risk begins to be significant 8 years after the onset of pancolitis (involvement of entire large intestine), or 12-15 years after the onset of left-sided colitis


Recommended Test(s)
Colonoscopy every 1 to 2 years with biopsies for dysplasia


Comment
These people are best referred to a center with experience in the surveillance and management of inflammatory bowel disease.

Recommendations from other groups:


RECOMMENDATIONS OF MAJOR SOCIETIES — Optimal surveillance strategies for CRC in patients with inflammatory bowel disease (IBD) have not been established. The following recommendations have been issued by the major national societies in the United States and the British Society of Gastroenterology.

Ulcerative colitis



American Gastroenterological Association — Guidelines issued by the American Gastroenterological Association (AGA) recommend the following:

●Colonoscopic surveillance should begin after eight years in patients with pancolitis, and 15 years in patients with colitis involving the left colon

●Colonoscopy should be repeated every one to two years



American College of Gastroenterology — Guidelines issued by the American College of Gastroenterology (ACG) recommend the following:

●Annual surveillance colonoscopy beginning after 8 to 10 years of disease in patients who are surgical candidates

●Multiple biopsies should be obtained at regular intervals

●The finding of definite dysplasia (of any grade) should be confirmed by an expert pathologist and is an indication for colectomy

●Patients whose biopsies are indefinite for dysplasia after review by an expert pathologist should undergo repeat surveillance colonoscopy at a shorter interval

●The ACG recommendations do not specify whether surveillance can begin later in patients with disease limited to the left colon



American Society for Gastrointestinal Endoscopy — The American Society for Gastrointestinal Endoscopy (ASGE) guidelines recommend the following:

●Patients with ulcerative colitis who have pancolitis should begin surveillance colonoscopy after eight years of disease.

●Four biopsies should be obtained every 10 cm from the cecum to the rectum. In addition, any suspicious lesions or masses should be biopsied.

●Colonoscopy should be repeated every one to three years.

●The finding of carcinoma or high-grade dysplasia is an indication for colectomy. Colectomy is also indicated for any degree of dysplasia associated with a lesion or mass. The finding of dysplasia should be confirmed by an expert pathologist.

●The finding of low-grade dysplasia should be confirmed by an expert pathologist. The ASGE acknowledges that most experts recommend colectomy. However, in patients in whom colectomy is not feasible or is unacceptable, frequent surveillance (eg, every three to six months) is considered an acceptable alternative.

●Patients with left-sided colitis surveillance should begin surveillance after 15 years of disease. Surveillance is not indicated in ulcerative proctitis. The ASGE also recommends that prophylactic colectomy should be considered in patients with longstanding colitis. The definition of longstanding was not specified.



British Society of Gastroenterology — Guidelines issued by the British Society of Gastroenterology in 2002 and updated in 2010 recommend the following:

●Surveillance colonoscopies should be performed when the disease is in remission, if possible. However, a surveillance procedure should not be unduly delayed if remission cannot be achieved.

●All patients should have a surveillance colonoscopy 10 years after the onset of symptoms to assess disease extent and other endoscopic risk factors.

●The interval for surveillance colonoscopy depends upon the duration and extent of disease and the presence of additional risk factors (eg, family history of colon cancer or primary sclerosing cholangitis).

Surveillance should be performed every five years for patients at lower risk (extensive colitis with no active endoscopic or histologic inflammation, left-sided colitis, or Crohn colitis involving less than 50 percent of the colon).

Surveillance should be performed every three years for patients at intermediate risk (extensive colitis with mildly active endoscopic or histologic inflammation, post-inflammatory polyps, or a family history of colorectal cancer in a first-degree relative who was at least 50 years of age).

Surveillance should be performed every year for patients at higher risk (extensive colitis with moderately active endoscopic or histologic inflammation, a stricture in the preceding five years, dysplasia in the previous five years that was not treated surgically, primary sclerosing cholangitis, or a family history of colorectal cancer in a first-degree relative younger than 50 years of age).

●Pancolonic dye spraying with targeted biopsies of abnormal areas. If chromoendoscopy is not used, two to four random biopsy specimens every 10 cm from the entire colon should be taken with additional samples of suspicious areas.

●If a dysplastic polyp is detected within an area of inflammation and can be removed in its entirety, it is not necessary to recommend colectomy.

●Postcolectomy surveillance with yearly flexible sigmoidoscopy of pouch/rectal mucosa should be considered for patients at high risk (previous rectal dysplasia or dysplasia or colorectal cancer at the time of pouch surgery or primary sclerosing cholangitis or type C mucosa [mucosa exhibiting permanent persistent atrophy and severe inflammation] in the pouch). In patients with none of the risk factors above, five-yearly flexible sigmoidoscopy of pouch/rectal mucosa should be considered.

i've read many medical articles that say that colon cancer does not happen in ibd-ers more often than it does in people without uc. Doctors who claim it are simply fear mongers because it is in their vital interest to have us come for medical consultations as often as possible. If uc were so much colon related, so why are there so many people who develop cancer suddenly without any ibd record? All of us have very fragile mucus so in our case colonoscopy is something extremely invasive which (in my opinion) may cause more harm than benefit.

Again - I would ask the doctor to justify a colonoscopy yearly, every other year, etc. Do they really not know what is going on? If they do not know how to treat you maybe another doctor does. Why a colonoscopy and not a flexsig. Not that I would do a flexsig every year.

Having plenty of family members in healthcare one of the things they point out; bad doctors consistently refer to specialists no matter what and bad doctors run unsubstantiated tests.