Colonoscopy theory
Risks:
[edit | edit source]- Serious harm in 2.8 per 1000
- And 85% of those in s/o polypectomy
- Mortality 0.007%
- Related to sedation
- Preparation
- Bleeding
- Perforation - 1 in 1000 screening, 1 in 500 for all
- Infection
Right colon lesions are more likely to be missed - more likely to be flat
Should take >6min withdrawal - more likely to find any polyp and also malignant polyp
Selective application of dye spray (eg indigocarmine) can assist with detection.
- Not routinely used since time-consuming and messy, and mostly helps find diminutive non-malignant polyps
- Useful in ulcerative colitis dysplasia detection
Narrow band imaging can be helpful with detection of flat adenomas and differentiation of malignant/benign lesionsin particular, but hasn't been shown to increase ADR for average-risk patients.
Quality indicators (Australian Commission on Safety and Quality in Healthcare
[edit | edit source]- Procedure
- Whole colon and caecum examined carefully and systematically
- Document adequacy of bowel prep, clinical findings, biopsies, polyps, therapeutic interventions and adverse events.
- Submit all polyps for histology
GESA recertification requirements
[edit | edit source]- >95% of procedures to caecum or TI of intact colons
- 25% adenoma detection rate >50yo
- SSA detection rate >4% >50yo
SCV recommendations
[edit | edit source]- 6 minute withdrawal time