What are my choices of facility when having a colonoscopy?
Colonoscopy is usually performed at a designated facility located either within a hospital, or at a free-standing ambulatory surgical center (ASC). Either of these facilities is required to undergo a rigorous licensing process for the privilege to perform these procedures. This licensing requirement ensures that a facility meets the accepted standard necessary to provide safe and qualified colonoscopy examination.
What is an ASC?
In order to be obtain a license to perform a colonoscopy, a facility has to fully demonstrate to a regulatory agency that it is not only operational, but has met its exacting standard. In fact, every aspect of procedure performed at a facility is meticulously reviewed, usually over a course of several days. As a start, this involves review of all necessary equipment, monitors, and emergency power generator (in case there is an earthquake). In addition, a facility has to demonstrate that each and every necessary nursing and ancillary personnel has an appropriate licensure, credentialing, and training, so that procedures can be performed and completed safely. Finally, a facility has to demonstrate that it performs a regular quality improvement program and upholds the highest safety standard.
In turn, for your gastroenterologist to be able to perform colonoscopy at a particular facility, he or she will need to undergo a rigorous credentialing process that ensures that he or she possesses necessary qualifications and skills to perform the procedure. For example, when granting a privilege to perform colonoscopy, the facility will require that your gastroenterologist have a documentation and proof of licensure, board-certification, assessment by his or her peers for character and qualification, and a certification of having satisfactorily performed a designated number of colonoscopies in the past several years.
What is an advantage of having a colonoscopy done at an ASC?
The decision on where your colonoscopy will be performed, in most cases will be determined by your gastroenterologist. Factors that may be important in the selection process may include his or her personal preference; facilities in which he or she has privilege; geographic consideration; availability of desired time and date at a particular facility; and your insurance coverage.
In general, a facility located within a hospital has the advantage of having the full resource of a hospital should you require them. On the other hand, ASCs tend to be more economical and time-efficient since they are not encumbered with work related to inpatients. Most individuals find that for a routine screening colonoscopy, it is significantly more convenient and economical to have the procedure done at an outpatient ASC.
Gastroenterologist:
Colonoscopy is generally performed by a specialist called gastroenterologist. Gastroenterologist is sometimes called GI specialist (Gastro-Intestinal) or simply a stomach doctor. A gastroenterologist is a physician who has undergone a special training in the discipline of gastroenterology, which requires about 6 years of additional training (both internal medicine and gastroenterology) after graduating from the medical school. That is 26 years of school and training in total!
In general, GI doctors are required to perform a certain number of gastrointestinal procedures to complete their respective training programs. To be board-certified in gastroenterology, one also needs to pass a rigorous certification examination. In addition, most gastroenterologists maintain their skill by continuously performing certain number of cases each year, and attending annual continuing medical education programs.
Services offered by a gastroenterologist may include:
- Consultation on various conditions affecting the GI tract.
- Colonoscopy
- Upper Endoscopy
- Sigmoidoscopy
- ERCP (a special procedure that allows an examination of the bile duct and pancreas)
Common symptoms or conditions for which a GI specialist may be sought include:
- Colon cancer screening
- Abdominal pain
- Diarrhea
- Ulcers
- Hemorrhoids
- Constipation
- Heartburn (Acid Reflux)
- Irritable Bowel Syndrome (IBS)
- Crohn's Disease
- Gallbladder disease and gallstone
- Hepatitis
- Helicobacter pylori
- Cancers of the GI tract including colon cancer, stomach cancer, pancreas cancer, or liver cancer
Colon Cancer at a Glance:
Colon cancer is the second most common cancer in the U.S., and a leading cause of death related to cancer. In fact, there are nearly 150,000 new cases of colon and rectal cancers diagnosed each year, just in the U.S. In fact, there are twice as many individuals dying from colon cancer than from motor vehicle accidents!
Like most cancers, the risk of colon cancer increases with age, particularly after the age of 50. The incidence increases gradually over time afterwards. As a result, most individuals are recommended to undergo screening colonoscopy starting at the age of 50. If the initial colonoscopy shows no abnormality and the examination is of good quality (e.g. the gastroenterologist was able to adequately examine the colon and the preparation was satisfactory), then a follow-up examination is advised every 10 years thereafter. However, if an abnormality such as polyp is found, then subsequent examination will be decided likely be dependent on the size, number and type of polyp found. In addition, if there are other symptoms such as bleeding, abdominal pain, weight loss, or change in bowel habit, a follow-up examination will have to be tailored depending on the extent of these symptoms.
For those with a family history of colon cancer or polyp, the current recommendation is to move up the first screening examination to 40 and repeat it every 10 years, since there is an increased risk of developing colon cancer in these individuals.
Fortunately, colon cancer is one of few cancers that can be entirely prevented by having a timely screening examination. This is because cancer can be easily treated at an early stage, and some can even be removed during colonoscopy, before it has a chance to grow, spread, and become difficult to treat. In fact, the risk of developing and dying from colon cancer can be essentially eliminated by undergoing a simple screening colonoscopy examination. Therefore, having a colonoscopy can be a life-saving decision!
