Colonoscopy Risks & Complications
Colonoscopy Screening Is Actually Not needed
Ever since the early years after the development of colonoscopy in 1969, the method has been assaulted as being excessive and unnecessarily hazardous. Even so, with a colonoscopy priced at as much as $3,000 per procedure, it is now the defacto standard for colon cancer prevention. That esteemed position is currently being dropped because of newly released medical publications exposing the reality regarding colonoscopies. Gastroenterologists need to expect their incomes to be reduced by at least one half when the truth gets to be more wide-spread, particularly in this climate of out-of-control health care spending.
As a young physician in the 1970s I used a stiff two-foot long sigmoidoscope to evaluate my patients for hemorrhoids, colon polyps, and cancer. The process was distressing, comparatively risk-free, cost about $100, and could be done within ten minutes with no sedation at my office. Colonoscopies came into common use as a screening device in the late 1970s. Since this instrument (the colonoscope) must traverse six feet of torturous and winding colon with 4 right angle turns (as opposed to merely two feet with 2 bends using a sigmoidoscope) far more is involved. The colonoscopy needs a complete colon preparation (lasting as much as 3 days), sedation, and a minimum of a half-hour to complete. The hazards from the sedation and passage of the tube are substantial. By comparison, these days a far more comfortable sigmoidoscope exam (employing a flexible type device) can be performed, which usually calls for no more than a day of preparation, costs around $200, and will be finished in ten minutes. No sedation is necessary and injury is almost never caused to the patient. Properly trained health professional practitioners can do flexible sigmoidoscopy as effectively as gastroenterologists can.
Gastroenterologists who prefer colonoscopy over sigmoidoscopy reason that neglecting to examine the proximal (right hand side) 3 to 4 feet of the bowel (that can't be reached by the sigmoidoscope) is medical malpractice. One medical editor in 2000 metaphorically declared, “Relying on flexible sigmoidoscopy is as medically reasonable as undertaking mammography of just one breast to screen women for breast cancer.” Nonetheless, the medical studies, even at that time, didn't demonstrate any real benefit from employing colonoscopy over sigmoidoscopy for colorectal cancer prevention. However as a result of self-serving and monetary benefits of colonoscopies, sigmoidoscope exams swiftly became unfashionable as a screening device for cancer.
The Movement Back to the Sigmoidoscope
This colonoscopy-dominated tendency did start to change in January of 2009 when a thorough evaluation of the results of colonoscopy was documented in the Annals of Internal Medicine. Although the total 5 feet of colon was looked at with the colonoscope, prevention of fatalities from colorectal cancer were restricted to just those polyps taken out of the left side of the colon-those last 2 feet which are conveniently and safely within the reach of a sigmoidoscope. The conclusions shook the world of gastrointestinal medical care.
The next big occurrence was the publication of the “Once-only flexible sigmoidoscopy screening in prevention of colorectal cancer: a multicentre randomized controlled trial,” printed in the May 8, 2010 publication of Lancet. This research has become the waterloo for the colonoscopy field. In this enormous endeavor, 432 individuals 55 to 64 years old had been assigned to either once-only flexible sigmoidoscopy or no screening. For individuals who finished the sigmoidoscopy screening the occurrence of colorectal cancer was lessened by 33% and death by 43%. (Small polyps were taken out in the course of the exam.) Follow-up colonoscopy was restricted to those individuals having polyps which met high-risk conditions: 1 centimeter or bigger; 3 or more adenomas; tubulovillous or villous histology; extreme dysplasia or malignancy; or twenty or higher hyperplastic polyps above the distal (left side) rectum. Only 5.3% of the people continued to colonoscopy.
Why Are Advantages Restricted to the Left Bowel?
The reasons that survival gains are limited to polyps taken from the distal (left) bowel are not known, however there are a few suspicions. There are technical factors in that the proximal (right) side is more difficult to completely clean out for visual images plus more challenging to move the scope entirely into. Furthermore, right and left colon cancers could differ biologically: right-sided cancers are sometimes flat, causing them to be more difficult to recognize and remove. Right-sided colon cancers are usually a great deal more aggressive and dangerous, and consequently they'll more infrequently be present in a precancerous polyp stage, prior to spreading (metastasized).
Colonoscopy is definitely an imprecise device. Colon cancer comes from polyps (also known as adenomas), and these kinds of tests overlook approximately 24% of polyps - 12% being large polyps (10 mm or larger). In autopsy studies, around 35% of individuals eating the usual Western diet are discovered to possess colon polyps. Two-thirds of colorectal cancers and adenomas are found within the rectum and sigmoid colon, which, as stated, may be examined by flexible sigmoidoscopy.
Exactly Why Is A Single Exam Adequate?
The size of a polyp found on exam is definitely a sign as to just how long and how aggressively the polyp has been developing. Big polyps, that are farther along this developmental pattern, are more inclined to be cancerous. Polyps under 5 millimeters (1 / 2 inch) usually are not apt to be malignant, while 1% of polyps 10 millimeters in size indicate cancerous variations, escalating to 17% at 20 mm. Fewer than 1 in 20 smaller polyps will grow bigger and change into cancer.
90 percent of colorectal cancers take place following the age of fifty-five. Conversion time from the initial modifications in the mucous membranes of the colon to the commencing of true cancer takes on average 10 to 15 years. After the cancer gets started, the time for metastasis (dispersing to various other areas of the body), and ultimately death, requires an additional 10 to 20 years, As a result, the entire progression from ordinary cells to cancerous cells and loss of life will span an average of 20 to 35 years. If a single flexible sigmoidoscope exam is effectively done between age 55 and 64, without any polyps (or any time polyps are discovered, they're properly taken out) then the chance of death from left-sided colon cancer has for all realistic purposes been removed. In the real world, if a polyp destined to turn into a cancer happened to get started on the very next day following your examination, then you would most likely pass away from different causes (cardiac arrest, stroke, old age) a long time before the cancer had gotten to you. (As mentioned previously, there exists a danger of death as a result of colon cancer by overlooked polyps and cancers inside the proximal colon.)
Colonoscopy Screening Is an Unnecessary Risk
When it comes to making a choice regarding whether or not to get a screening done, the advantages and dangers to you have to be taken into account. The total danger of acquiring colon cancer for folks pursuing the Western diet is 2.5%. If you have a single first-degree family member having colon cancer this raises the threat to 4.7%, and with 2 family members the danger turns into 9.6% (up to the age of 75). This enhanced danger is in part hereditary, but also understand that mother shows daughter and son the way to prepare food and what to eat.
Injuries from a colonoscopy might occur with the preparation, the sedation, and also the process. In the USA, severe injury happens in approximately 5 per 1,000 procedures. Whenever biopsies or polyp removals are performed, then the danger of significant difficulties, like hemorrhaging, will increase. One of the most significant dangers, frequently bringing about loss of life, will be perforation of the colon, which happens in about 1 per 1,000 procedures. Facing that disaster, take into account that in order to avoid a single loss of life from colorectal cancer (the main benefit), 1,250 individuals will need to have a colonoscopy. This is just about an even trade: for just one life spared from cancer, one life is forfeited (or at best very seriously endangered) by a complication, like perforation.
This was adapted from an article written by Dr. John McDougall, MD. For more information, do a web search for “McDougall Colonoscopy.” Dr. McDougall is a board certified internist and an internationally known researcher, author and lecturer who teaches the benefits of a low fat, plant based diet.
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