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Colonoscopy & Polyps

Colonoscopy and Polyps

March 6, 2012
12:00 p.m. – 1:00 p.m. (EST)

Tolga Erim, DO - Gastroenterologist

Cleveland_Clinic_Host: Today's Live Web Chat, "Colonoscopy and Polyps" with Tolga Erim, MD will begin at 12 noon EST. Please submit your questions by typing them below and then clicking 'Ask'.

Minnie: Please explain the difference between a flex sig and colonoscopy, and the advantages or disadvantages of both. Also, I would like to know if there are any improvements coming in the prep for either.

Dr_Erim: You can think of a flex sig as a 1/3 colonoscopy. A shorter length of colon is examined. The advantage is that there is less risk of a complication such as perforation, but of course, you can only see a portion of the colon rather than the entire colon.

nance: I have a history of polyps, which have been removed during colonoscopy procedures. My scheduling has been every 5 years. My Question: I am 80 years old, and following my most recent procedure in 2011, my gastroenterologist told me that statistically, I would not be scheduled for further procedures (having to do with federal guidelines I am assuming). However, my father died of colon cancer at the age of 86. So, between my history of polyps and my father's colon cancer, I am at high risk for colon cancer. In my particular situation, what is your opinion on the importance of future colonoscopies?

Dr_Erim: Nance, that is a great question. This is a topic that is frequently debated. We have a segment of our population that is quite healthy at age 85 and is expected to live well into their 90s. Polyps grow slowly, over many years, and the potential of a small polyp developing into cancer is quite low. The reasoning behind the recommendation is that the procedure may pose harm with very little benefit. However, some hold the opinion that if you are in good health with a long life expectancy, it is not unreasonable to have another screening colonoscopy at 85. I do not disagree with this.

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jackpat2: Statistically, how often are polyps missed on a Colonoscopy exam in the USA

Dr_Erim: Up to 10% of polyps that are as large as 1cm may be missed.

RaffTaff: I recently had a colonoscopy and a few polyps were found. Do all polyps eventually turn into cancer? How concerned should I be?

Dr_Erim: No, not all polyps are precancerous. Hyperplastic polyps do not have this potential. Adenomatous polyps are the ones we are concerned about. These occur in up to 20-30% of women and men in their 50s, rates become higher as we get older. It takes many years for an adenomatous polyp to advance into a cancer.

mlqbc369: My husband recently had a procedure done, we were thinking that he was getting a colonoscopy but he ended up getting a sigmoidoscopy. What is the difference between the two?

Dr_Erim: Sigmoidoscopy is like a partial colonoscopy, it does not evaluate the beginning and mid part of the colon for polyps. It is not as highly utilized currently in the US because it cannot address the right sided colon lesions.

jackpat2_1: Those are bad odds for the patient....how fast may these become a malignancy?

Dr_Erim: very very slowly. It takes many years for a polyp to grow and many years for it to advance to a cancer. Vast majority of polyps that have turned into cancer are larger than 1cm in size.

johnnnita: About 7 years ago, I had my first full colonoscopy. It went fine with results (no polyps, etc.). I am now almost 63. During my annual physical last month, I asked my internist if I should have another one now or wait until the 10 year period comes up. When I had my colonoscopy 7 years ago, the doctor who performed it said I should have another one after seven years. I asked my doctor last month about this, and he said I could wait until after 10 years for the next one. What is your opinion on this?

Dr_Erim: You should follow the advice of the person who performed the colonoscopy. We routinely alter our surveillance interval recommendations according to how good an examination you may have had originally. Its 7 years for you, not 10.

sammi56: My 68 year old grandfather had a colonoscopy done last year and now it is time for his annual check-up. Last time he was very drossy for about a day, is there something we can do this time to change this?

Dr_Erim: We use several different medications for sedation. He would probably do better with propofol, it wears off quickly and with little after effects. I would advise him to bring this up wit his GI physician before his next indicated colonoscopy.

Cleveland_Clinic_Host: If you would like to view the entire transcript of this chat after the event, it will be available on the Cleveland Clinic Florida website. If you have logged in during the middle of this chat and want to view what has already been discussed, click on the transcript button on this page.

raf7659: I've had recurrent hemorrhoids for several years. Is there any relation between the hemorrhoids and rectal polyps? I’m also interested in getting a colonoscopy soon; can I do it with hemorrhoids?

Dr_Erim: No relation between hemorrhoids and polyps. No problem with having colonoscopy if you have polyps. They may get a bit raw with the prep though :)

pipermen: I’ve heard about getting an x-ray done rather than a colonoscopy, what is the difference and which one is better than the other.

Dr_Erim: CT colonography is an option for colon cancer screening. It requires the same prep, there is no sedation and you will have to have air instilled in the colon on the CT scan machine. If polyps larger than 6mm are noted, you will have to have a colonoscopy. It also is not good at identifying flat polyps. The surveillance interval is shorter, about 3 years or so. The biggest advantage of CT colonography is that it has less risk of perforation, although it is not zero and has been reported. Also, they may not report polyps smaller than 6mm at all, there have been advanced dysplasia or malignancy discovered in polyps that are as small as this. So it raises an ethical issue. My opinion is that it is not as good as a colonoscopy at this time.

agort54:Three years ago, I had a large tubulovillous adenoma polyp removed, the year after that a hyperplastic polyp was removed. Should I have an immediate ultrasound, MRI to discover if any other organ, tissue abnormalities exist?

Dr_Erim:There is no indication for an US or MRI based on that single polyp you had removed. If something is noted, it would not be because of the polyp but due to chance.

MRSteveNY:If during the procedure the doctor finds something, do they remove it immediately or do we have a choice on what is done next.

Dr_Erim:We do remove it usually, however, if a very large polyp is found I will not remove it, I will discuss the next possible steps with my patients after they wake up.

swrobel: What is the age that is recommended for a first full colonoscopy for women?

Dr_Erim:For average risk patients, 50.

nance:In 1998 I had mitral valve repair at the Cleveland Clinic (Dr. Cosgrove). I understand that I am to take antibiotics prior to invasive procedures, including dental work. Would this apply to colonoscopy procedure? When I requested antibiotics at my last procedure, the staff did not think this was necessary, however, I insisted. Your opinion? Thank you.

Dr_Erim:Not necessary per our and the cardiology guidelines for a colonoscopy.

johnnnita:should there be any concerns having a colonoscopy if you have had open heart surgery in the past, complicated by post surgery atrial fibrillation? Since then, I've had no atrial fibrillation, but low pulse. What are the implications, if any, for being under "dreamlike" sleep during the colonoscopy procedure?

Dr_Erim: Colonoscopy is considered a low risk procedure in terms of preoperative risk staging. I would advise you to discuss with your cardiologist if you should have any special precautions before colonoscopy. Usually, it is not an issue.

Cleveland_Clinic_Host: We have been receiving great questions so far! We have about 20 minutes left in this chat. Keep the questions coming.

swrobel: what is average risk patient? My grandmother died from colon cancer - no problem with either parent.

Dr_Erim: Your grandmother confers a slight increase in risk but you would be considered average risk. The highest risk would be more than one 1st degree family member with colon cancer or one with colon cancer earlier than age 60.

ALNBARB: About a year ago, I had two polyps removed and then my PCP recommended that I get on a regiment of calcium tablets and low dose aspirin. Is there any solid facts that this helps fight against another flare up of polyps?

Dr_Erim: Not much date behind calcium. But there is some data that suggests aspirin at doses 325mg for more than 10 years may be of benefit but patients were having significant bleeding episodes, more information is needed on benefit versus risk before this can be recommended.

bsmith: My dad is 92 and in great health. We still take him for his regular colonoscopy check up but it has become harder for him to be mobile. Is it still necessary for him to have colonoscopy done? He’s never had any polyps or symptoms.

Dr_Erim: Not necessary any more for him.

naturelady:I had my colonoscopy at 61. The doctor found that I had one polyp. It was not precancerous. Yet, he told me to have another colonoscopy in three years. Should I be worried?

Dr_Erim: Not necessarily, it may be that you did not have a very good prep and he may not have felt it was an optimal examination.

mclaypool_1:I am 44 with no family history of colon cancer. I do have a personal history of chronic diarrhea. When should I have my 1st colonoscopy?

Dr_Erim:For screening purposes, at age 50, unless you are African American, then I suggest age 45. Although, your GI physician may recommend colonoscopy for evaluation of the diarrhea.

dominiqueh:my gastroenterologist recommended a virtual colonoscopy but I’m a bit concerned because I read that you can be exposed to high amounts of radiation, what are your thoughts?

Dr_Erim: In addition to what I wrote above about CT colonography (virtual colonoscopy), there is the very real aspect of radiation. A CT scan exposes you to some radiation which is not very high if you get only a few in your lifetime but if you are going to have one every few years then it is something to think about. It is difficult to put a number on it because different CT protocols/institutions/machines expose you to different levels of radiation.

swrobel: is there any correlation of someone with chronic constipation and having increased risk of cancer? Chronic constipation is as a result of MS attacks we speculate.

Dr_Erim:No added risk for those with constipation. However, constipation can present as a symptom of colon cancer. It must be evaluated.

MissLyss:Can my primary care doctor do my colonoscopy or do I have to see a specialist?

Dr_Erim:The single most important factor in the quality of the screening colonoscopy you get is the endoscopist. I would recommend a well trained Gastroenterologist.

scg367:At what age should adult men get there colonoscopy done?

Dr_Erim:At age 50 for average risk, 45 if you are African American.

Cleveland_Clinic_Host:I'm sorry to say that our time with Tolga Erim, DO is now over. Thank you again, Dr. Erim, for taking the time to answer our questions today about Colonoscopy and Polyps. To make an appointment with Dr. Erim, or any other specialists at Cleveland Clinic Florida, please call 877.463.2010. You can also visit us online at vanity clevelandclinicflorida.org.