As primary-care providers, we are challenged every day to make recommendations to our patients for age- and gender-related preventive screening tests. Some type of colorectal cancer (CRC) screening test should be performed around age 50 for men and women at average risk for the disease.
Still considered the gold standard for CRC screening, colonoscopy enables direct visualization of the lining of the colon and rectum while allowing the endoscopist to biopsy or remove polyps or suspicious lesions at the same time.
If a patient decides to have a colonoscopy or if the test is highly recommended because the patient has a first-degree relative with CRC, we can empower him or her with a few written instructions to help ensure that the colonoscopy is safe for the patient and has an optimal procedural outcome.
As the first gastroenterology nurse practitioner in Pennsylvania credentialed to perform colonoscopy and having undergone two colonoscopies myself, I have learned what really matters when shopping around for a good gastroenterologist.
Some endoscopy centers are more like assembly-line factories. Polyps and lesions could be missed because the endoscopist does not spend enough time looking for abnormalities, or because of operator fatigue, or because surveillance is recommended sooner than expected by gastroenterology guidelines.
Endoscopists are supposed to meet or exceed colonoscopy performance indicators when doing the procedure. Those indicators include reaching the cecum, describing the bowel-preparation quality, and making appropriate surveillance recommendations (Gastroenterology. 2012;143:844-857).
In addition, precancerous polyps should be detected at least 25% of the time in men and at least 15% of the time in women, as noted by Douglas K. Rex, MD, in 2007 in Journal Watch Gastroenterology (Rex DK. Journal Watch. 12 Jan 2007. Available at gastroenterology.jwatch.org/cgi/content/full/2007/112/1).
Here are a few tips we can share with patients who are contemplating having or already planning to have a screening colonoscopy:
- For an excellent bowel preparation, the patient should stop consuming dietary fiber at least three days prior to the colonoscopy.
- The patient should drink strictly clear liquids and have no solid food for 24 to 48 hours before the colonoscopy based on his or her defecation frequency, prescribed medications, and exercise patterns.
- The patient should follow a split-dose bowel-cleanser preparation regimen in which the first dose is taken 8 to 10 hours before the second to improve the patient’s tolerance of the preparation formula and to enhance endoscopic visualization.
- When meeting with the gastroenterologist, the patient should ask what the physician’s precancerous (adenomatous) polyp detection rate is and what the physician’s typical scope-withdrawal time is. Scope-withdrawal time should exceed six minutes; otherwise, polyps and lesion could be missed.
- The patient should ask the gastroenterologist which group’s guidelines the physician uses when recommending a surveillance interval schedule, such as the American Society for Gastrointestinal Endoscopy.
Jordan Hopchik, MSN, FNP-BC, is a gastroenterology nurse practitioner at the Philadelphia VA Medical Center and a Doctor of Nursing student at La Salle University in Philadelphia.