Study Questions Colonoscopy Effectiveness

A new study published in The New England Journal of Medicine found that of 12 highly experienced board-certified gastroenterologists in private practice, 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. They discovered that those who slowed down and took their time found more polyps.

“Patients assume that one colonoscopist is as good as another,” said Dr. Douglas K. Rex, a gastroenterologist and professor of medicine at Indiana University who did not take part in the study. “But these are dramatic differences.”

The Rockford study was preceded by other signs that colonoscopies are by no means foolproof. The first indication that colonoscopies were not as effective as widely believed came with two studies, one in 1991 and a larger one, in 1997, in which patients had two colonoscopies on the same day. Those studies showed that doctors were missing 15 to 27 percent of adenomas, including 6 percent of large adenomas. Then, in the last few years, two studies of so-called virtual colonoscopies, which use a CT scan to view the colon, found that the rate of overlooked adenomas in traditional colonoscopies was even higher. Patients in those studies had traditional and virtual colonoscopy on the same day. Traditional colonoscopies missed 12 to 17 percent of the large adenomas detected in the virtual colonoscopies.

The study by the group in Rockford suggests a way to improve colonoscopy: by slowing down. “If you rush things, you miss things,” Dr. Schoen said. That happens in part because reimbursement rates for colonoscopies have fallen in recent years, and some doctors are doing the exams faster than ever, Dr. Schoen and others say. The Rockford group concluded that doctors should take at least eight minutes to withdraw the endoscope.

Dr. Douglas J. Robertson, a gastroenterologist at Dartmouth University and at the White River Junction VA Medical Center in White River, Vt., said it did not hurt to ask for a doctor’s detection rate. “If you are met with a total blank stare,” Dr. Robertson said, “that tells you the doctor is really not clued in to quality issues and is not listening at national meetings.”

Courtesy NY Times

Bonnie - it is astounding that the virtual colonoscopy is not used more. Make sure you do your due diligence before doing a traditional colonoscopy.