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Colon Cancer

Colonoscopy question

05/25/2007

Question:

I`m 50 with a family history of colon cancer and have recently started having some bleeding and a change in bowel habits; my doctor has suggested a colonoscopy. The GI doctor that I was sent to said that my request the test without sedation was impossible (which I know is wrong) and sent me on my way. I am an airline pilot really don`t want the drugs; this isn`t an anaesthesia question....my question is basically: can I just get by with a flex-sig and FOBT or do I need to call around and find someone who will do the colonoscopy without drugs? Is the flex good enough to get by with given the fact that my dad died of colon cancer? Thanks for your help; my primary doc is being quite dismissive when I ask her these questions. Thanks.

Answer:

The age for obtaining a screening colonoscopy in an average risk individual without symptoms is 50; this age drops to 40 when an individual has a first degree relative with colon cancer. Your Father's history, which gives you and your siblings a colon cancer history necessitates screening at age 40, or in your particular case certainly now. While there are other combinations of screening that are currently "accepted" standards for average risk individuals, for someone with a first degree relative who has or had colon cancer, the standard is complete mucosal evaluation with a colonoscopy. You should except nothing less then a colonoscopy and this should be done now. Your siblings, if you have any, who are over 40 should also be screened.

Regarding sedation, colonoscopy can be and is performed without sedation. There are physicians who will perform colonoscopy without the use of sedation if the patient requests such. The amount of sedation given varies from a small amount to larger amounts based on the practitioner's skill level, experience with sedation, and patient comfort during the procedure. Calling around may be the only way to find someone who will do it without sedation. Before allowing someone to do this procedure on you without sedation, make sure they have previously done it for others. You want someone who has a high volume of procedures - usually gastroenterologists or colorectal surgeons. Ask about their number of cases performed per year, their average withdraw time, and their complication rates.

If because of your profession you are worried about drug testing because of medications used for sedation, you can always obtain a letter from the physician performing the procedure stating what medications were given.

 

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Response by:

James I Merlino, MD James I Merlino, MD
Assistant Professor of Surgery
School of Medicine
Case Western Reserve University