The Truth About Colonoscopy: Be informed before giving consent (Part 1)
Colonoscopy is the most commonly used method to screen for colon cancer, which is said to account for around 10% of all cancers globally. It is second leading cause of cancer death in men and women [combined] in the U.S. As of 2020, approximately 69% of adults aged 50 to 75 years have had a least one colonoscopy, representing 62.3 million people. Colon cancer is usually diagnosed when a person is in their 60s and it is more common in African Americans. For more stats about colon cancer go here.
A Short History of ColonoscopesThe first fiberoptic colonoscope was developed by Drs. William Wolff and Hiromi Shinya of Beth Israel Medical Center in New York City in 1969. This was a huge leap forward over a rigid pipe, called a sigmoidoscope, previously used to peer into the rectum of patients who had signs of cancer. The flexible scope allows the practitioner to examine the entire length of the colon. By 1973, more than 5,000 colonoscopies had been performed, demonstrating the utility and relative safety of the procedure.
In 1983, the Welch Allyn Corporation invented the first video endoscope, allowing doctors to see the procedure and view the colonic mucosa on-screen. Previously, they could only see the tissues through a small eyepiece.
More Costs To Consider
- Uninsured patients will likely be responsible for the total cost of their exam.
- Patients with health insurance will be responsible for paying their deductible, copay, and coinsurance amounts. The amount will depend individual health plans.
- Other expenses may include: the cost of the prep, cost of pain medications after the procedure,and of course, if there are complications, fees and costs may soar.
This site, called New Choice Health, allows you to search for the best pricing in your area.
With so many people out of work, under-employed, or without medical insurance coverage, be sure to shop around for the best pricing on any medical procedure you may be having, not just a colonoscopy. You may be very surprised what you may find by reviewing this site.
What Does a Colonoscopy Procedure Entail?
A Word About PolypsPolyps are irregular growths in your bowel. They are classified based on size and type to determine their risk of becoming colorectal cancer. While colon cancer is found in only about 40 out of 10,000 screening colonoscopies, almost all screens result in removing a polyp. In a study of 906 patients, aged 40 to 49 who had colonoscopy screening, it was found that at least 250 persons, maybe up to 1000 persons or more would need screening to detect one cancer. In financial terms, that would mean between $687,000 and $2,750,000 would needed to identify one case of colon cancer in asymptomatic, middle-aged persons.
Here is a case report of the costs of colonoscopy… and why doctors almost always find a polyp to remove: they can bill more. Removing a polyp changes the procedure from “preventive to diagnostic.”
- Total Bill: $10,329 for the procedure, anesthesiologist, and gastroenterologist. Cigna’s negotiated rate was $4,144, and the patient’s share under her insurance was $2,185.
Effect of Colonoscopy Screening on Risks of Colorectal Cancer and Related Death
Study researcher Dr. Michael Bretthauer, a gastroenterologist at the University of Oslo in Norway, said he found the results “disappointing” but worthy of consideration. He went on to say, “We may have oversold the message for the last 10 years or so, and we have to wind it back a little.”
Routine Colonoscopies be Challenged
Here’s an example:A study published in 2006 in the Annals of Internal Medicine reviewed 35,945 charts of patients who had undergone colonoscopies within the Kaiser Permanente, Northern California (KPNC) health care system. This is what they found (whole numbers reported here for clarity):
- Serious complications occurred in nearly 1 per 1000 exams without biopsy or polypectomy
- Serious complications other than bleeding occurred in 7 per 1000 exams with biopsy or polypectomy
- Bleeding occurred in nearly 5 per 1000 colonoscopies with biopsy62% of bleeding episodes and 40% of all serious complications occurred following removal of polyps smaller than 10 mm
- Perforation of the colon occurred more commonly with biopsy and occurred at a rate of almost 1 per 1000 exams
What does this study mean in real numbers?
Additional Complications“As the rates of using deep sedation with anesthesia during colonoscopy have increased markedly in recent years, there is concern that respiratory complications may be an increasingly common event.”
Risks of Infection after ColonoscopyThis study was the first to explore data on ambulatory surgery centers (ASC) and post-procedure infection.
Previously, post-endoscopic infection rates were thought to be around one event per million. The actual rate of infection within 7 days was found to be 1.1 per 1000 screening colonoscopy procedures; 1.6 per 1000 non-screening colonoscopy procedures (has a biopsy) and 3.0 per 1000 EDG procedures.
The rate of infections varied widely in different out-patient centers, ranged from 0 to 115 per 1000 procedures for screening colonoscopy; 0 to 132 for non-screening colonoscopy (polyp removed) and 0 to 62 for upper endoscopy.
Patients who’d been hospitalized before undergoing one of the procedures were at even greater risk of infection. Almost 45 in 1,000 patients who’d been hospitalized within 30 days prior to a screening colonoscopy returned to hospital or had an ER visit with an infection within a month. ‘
The Skill of the Examiner“The relative risk (RR) ratio was highest for endoscopists performing less than 591 procedures per year. Colonoscopy carried out by a low-volume endoscopist was independently associated with bleeding and perforation.”
“Although trainee endoscopists were involved in only 20% of the colonoscopies performed, eight (40%) perforations occurred while the training fellow was involved in the case.”
Among the 165 patients believed to be free of polyps after the first examination, 67 (41%) were found to have at least one polyp on the second examination whereas among the 191 patients believed to be free of adenomas on first colonoscopy, 27 (14%) were found to have at least one adenoma on the second procedure.