Time between colonoscopy

How long between colonoscopies? Can't really find a good chart.

Had uc for 25 plus years. Last scope 3 years ago. Some polyps but no issues. Taking asacol only.

So you are saying 3 years or 3.5 years is a long time between....

The answer depends on how far your ulcerative colitis extends and your case and family history. If you have uc limited to your rectum (ulcerative proctitis) then there is no specific colonoscopy interval to follow, it would be an entirely age based monitoring as typical for anyone over 50. If your ulcerative colitis involves both the rectum and sigmoid colon then biannual screening would be advisable. If your whole large intestine is involved then annual colonoscopy would be recommended.

Those are general guidelines, any questions then I'd certainly ask your gastroenterologist. If you've had a very mild and well controlled case they may not be as worried about you.

I have had U.C. for 35 years and get scoped EVERY year.

At our 2015 meeting my GI did not push for a scope although it is now 5 years since last scope. He said the latest research shows it is not beneficial if nothing indicates a need for it. In other words a c-scope is not finding cancer for UC when done frequently and there are more adverse events from scope than beneficial.

I've had UC for 15 years and had 3 scopes even though many of those years my flare was continuous. Never had any suspicious polyps in biopsy. But everyone's UC and IBD is different so being your own advocate not just doing what you're told is important.

Every new GI I go to wants to do their own c-scope and I always decline until I decide it's time, no GI has dropped me for that. Because of moving several times I've had 5 GI's (plus one died, one retired).

baconeggsyum said...
How long between colonoscopies? Can't really find a good chart.

Had uc for 25 plus years. Last scope 3 years ago. Some polyps but no issues. Taking asacol only.

I'm puzzled because there are many excellent charts out there. Are you rejecting these charts? Do you have some special circumstance not covered?

I just googled "How long between colonoscopies" and one of the top 3 hits was from American Cancer Society, and it had an Excellent Chart.

www.cancer.org/cancer/colonandrectumcancer/moreinformation/colonandrectumcancerearlydetection/colorectal-cancer-early-detection-acs-recommendations

The row about IBD said:

chart said...

Inflammatory bowel disease:

-Chronic ulcerative colitis
-Crohn’s disease

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

Colonoscopy every 1 to 2 years with biopsies for dysplasia

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

Since you had polyps and have UC for more than 10 years, I would get it atleast every 2 years. Its better to be safe than sorry.

I go every year because my Dr. likes new cars, and I like propofol.

;-)

I am 59. Diagnosed at 24. Family history of cancer. Polyps removed each time. 3 different Dr.'s all requested yearly. Even at Mt. Sinai Medical center, my Dr. wanted yearly scope. Mt. Sinai Medical center is where Dr. Burrill B. Crohn (A gastroenterologist) made the first major advance to identify the disease that now bears his name.

I belong to another group that is a somewhat support group for Crohn's an U.C. . I polled them last night. This morning I checked, the large majority get scoped yearly.

DBwithUC said...
Is it possible this was a more individualized recommendation tailored to your medical history? If so, it would be unfortunate to present it as a fact on a public forum.

Ima may have been concerned about too many colonoscopies because of her thread 2 years ago. Anesthesia and outpatient facilities were responsible for much of the risk:

www.healingwell.com/community/default.aspx?f=38&m=3116202

imagardener2 said...
Bottom line: anesthesia is a big and rising risk factor due to more people having c-scopes and endo-scopes in outpatient locations.
from the article:
Mortality rates have been reported to be 0.3% to 1.4% for ASA 2, 1.8% to 5.4% for ASA 3, and 7.8% to 25.9% for ASA 4 (Wolters U et al. Br J Anaesth 1996;77:217-222). In a more recent study, Bishop et al reported that major injury and death occurred in the outpatient setting 36.1% and 30.6% of the time, respectively (JAMA 2011;305:2427-2431)

I do not know what the ASA scale refers to but essentially there is more mortality or complications for the patient the greater their disease is and anesthesia is the reason given.
The article is written by an anesthesia nurse who is concerned that there is a move to "robot assisted" anesthesia rather than a real person. But the mortality figures given are for professionally assisted anesthesiology.

Here's the link but you may need to register to read it. I get email news from gastroendonews.com about 2 times a month or less.
www.gastroendonews.com//ViewArticle.aspx?ses=ogst&d=In+the+News&d_id=187&i=ISSUE%3a+June+2014&i_id=1072&a_id=27662

My take: go to a hospital not outpatient location if possible, lower mortality than outpatient settings. Don't use anesthesia if you do can do that (not sure that I can) especially with higher level of IBD involvement.

Seconder said...
There's been some debate about whether a nurse (or a even a GI) should administer propofol at all. Many nurses would prefer that an anesthesiologist administer it. The dosage is tricky, and there is a fine line between enough and too much. Once too much has been administered, there is no reversal. Advanced measures must be taken to maintain an airway until the effects wear off. All these safeguards are limited at a basic outpatient center.
 
A lot of people think a puncture will be the end of the scope coming through the colon, like a needle through cloth. That's not the case. When the scope gets "stuck," it needs to be reduced (unkinked), and sometimes the pressure of the side of the scope puts too much pressure on the side of the colon, like a curve in a curve. Effectively and safely reducing the cope takes times.
 
At some outpatient centers, propofol is used to speed up the scope so that as many scopes as possible can be performed in a day. The more sedated a patient, the less feedback, and the more likely that reducing the scope will lead to a puncture.
 
The general population should seriously reconsider surveillance scopes after a certain age. Without any extra risk factors, sedation is more likely to cause death than colon cancer. There are safer methods of screening colon cancer and more on the way.

imagardener2 said...

Therefore, at this time, most gastroenterology societies recommend that patients with at least 10 years of pancolonic ulcerative colitis undergo a surveillance colonoscopy every 1-3 years (depending on the society).

American Cancer Society says:
Inflammatory bowel disease
-Chronic ulcerative colitis
-Crohn's disease

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

Colonoscopy every 1 to 2 years with biopsies for dysplasia

These people are best referred to a center with experience in the surveillance and management of inflammatory bowel disease.
Seems we have to walk a fine line between risks of colon cancer and anesthesia.
And those over 70 or obese walk an even finer line

Post Edited (Coffeemate) : 4/12/2016 5:47:01 PM (GMT-6)

Louiseluck said...

DBwithUC said...

imagardener2 said...
... In other words a c-scope is not finding cancer for UC when done frequently and there are more adverse events from scope than beneficial....

This would be an interesting clinical finding. I read a lot of the literature and had not seen this. Do you have (or did you GI give) any study citation to support this, or any revised recommendations of American Cancer Society or American GI Society?

Is it possible this was a more individualized recommendation tailored to your medical history? If so, it would be unfortunate to present it as a fact on a public forum.

Apparently the American Cancer Society, or the American GI Society, etc. don't provide all the answers. So it isn't unfortunate to present alternative views on a public forum.

Louise -

You do not seem to understand or appreciate my point. Stressing the individualized aspect on forums is great. Pointing out that the medical societies only have AVERAGE answers based on best available research is a great thing to point out.

Sharing that in *your* case a different decision was made is GREAT. Sharing that your GI thought you could go longer based on reason X, Y, or Z is GREAT!

Saying "my GI said it is wrong to do this" as if it was new research or general knowledge is UNFORTUNATE. (Actually harsher terms, but I was being polite. It is ass'ey.)

I asked if this was new research. I asked if this was possibly an individualized recommendation?

I did everything polite. Your post is not helpful, because I never advocated for the suppression of anyone's decision or any alternative view. I said that representing the GI's words as new general research-backed advice was unfortunate - because it is WRONG AND DANGEROUS.

See my point?

Last night a show on TV explored the last hours of Joan Rivers who died after a 'routine' endoscopy. Some of the details are vague because the attending doctors are contradicting each other while being sued for negligence. But before her procedure Joan Rivers was in excellent health for her age with no underlying conditions.

Two of the major risk factors mentioned by imagardener2 are present here, anesthesia and going to an outpatient facility instead of a hospital. At first the log said she was given 300 mg of propofol, but that was later changed to 125 mg. The doctors at the clinic seemed clueless when complications arose. Finally instead of giving her a routine tracheotomy that may have provided enough oxygen to save her life, they called '911' and had paramedics move her to a real hospital where she later died.

Here is a video of the TV show:

www.dailymotion.com/video/x3gpvnj

Post Edited (Coffeemate) : 4/22/2016 6:58:11 AM (GMT-6)

There's statistically small risk in getting a scope and there's also risks in not getting a scope (especially with IBD patients with elevated CRC risks). Key thing is match your scope interval with your case history and follow recommendations by well regarded government health and gastroenterology resources for IBD patients, some of us need less frequent scopes than others (more frequent for long term uc, and family history of CRC). And say no, if you think a c-scope isn't necessary. Often a simple flexible-sigmoidoscopy is sufficient for diagnostics and even some CRC screening (if uc is limited to the rectum or sigmoid then why look at the entire large intestine?). I believe sigs have less risk as they go half as far, especially less risky when there's no anesthesia involved, and I'll take 2 fleet enemas over a gallon of movieprep any day lol.