Should You Get Another Full Colonoscopy After Previous Findings? - Surgery

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When considering whether to undergo another full colonoscopy after previous findings, several factors need to be taken into account, including your medical history, the results of previous examinations, and current symptoms.
In your case, you had a previous full colonoscopy four years ago that revealed a benign hyperplastic polyp in the sigmoid colon, which was less than 0.5 cm and was removed with normal pathology results. Two years ago, you underwent another colonoscopy, but it was incomplete, reaching only the transverse colon (approximately 60 cm) without any abnormal findings. You also mentioned experiencing hemorrhoids and occasional anal fissures, but you have regular bowel movements without significant issues.

Given this background, here are some considerations:
1. Incomplete Colonoscopy: The fact that your last colonoscopy did not reach the cecum (the beginning of the colon) is significant. An incomplete colonoscopy may leave undetected lesions or polyps in the distal colon, which could be a concern, especially considering your family history of colorectal issues. It is generally recommended to repeat the colonoscopy to ensure a complete examination of the entire colon.

2. Symptoms: While your current symptoms of occasional anal fissures and hemorrhoids are not uncommon, they do not necessarily indicate the presence of colorectal cancer or polyps. However, any changes in bowel habits, rectal bleeding, or persistent abdominal pain should prompt further investigation.

3. Family History: If there is a family history of colorectal cancer, it is prudent to be more vigilant with screening. Guidelines often recommend that individuals with a first-degree relative diagnosed with colorectal cancer before age 60 should begin screening at age 40 or 10 years earlier than the age at which the relative was diagnosed.

4. Guidelines for Follow-Up: The American College of Gastroenterology recommends that individuals with a history of adenomatous polyps undergo surveillance colonoscopy at intervals based on the number, size, and pathology of the polyps found. Since your previous polyp was benign, the recommendation might be less aggressive, but the incomplete nature of your last colonoscopy may warrant a follow-up sooner rather than later.

5. Risks of Repeating Colonoscopy: While there is a small risk of complications associated with colonoscopy, such as perforation or bleeding, these risks are generally low, especially in experienced hands. If your physician believes that a full colonoscopy is necessary, the benefits of obtaining a complete assessment of your colon typically outweigh the risks.

In conclusion, based on your medical history, the incomplete colonoscopy, and the presence of hemorrhoids and fissures, it would be advisable to discuss with your gastroenterologist the need for a complete colonoscopy. They can provide personalized recommendations based on your specific situation, including the timing of the procedure and any necessary preparations. Regular screening is crucial for early detection of potential issues, especially given your family history.