the Need for Repeat Colonoscopy: Risks and Recommendations

Q: the Need for Repeat Colonoscopy: Risks and Recommendations

Hello： 1. This type of polypectomy wound does not increase the risk of bowel perforation. 2. There may be difficulty in distinguishing the base. 3. If the physician recommends another colonoscopy, it can be performed after more than 4 weeks. 4. Dependi

Repeat colonoscopy?

Hello! I have anemia, and in early July, I underwent a colonoscopy at a health check-up clinic.
During the procedure, two tubular adenoma polyps were found: one is a 2mm sessile polyp in the descending colon (the polyp contains adenomatous changes, with crowded and disorganized tubular glands showing mild dysplastic features), and the other is a 2mm sessile polyp in the sigmoid colon (the polyp harbors extensive adenomatous change, with crowded and disorganized tubular glands showing mild to moderate dysplastic features).
However, when reviewing the report images, the second polyp with moderate dysplasia appears to be larger than 2mm, with a protruding part measuring about 1cm.
The primary physician only removed the front part (2mm) and did not take the back part (approximately 1cm).
When I inquired later, the physician insisted that only the front part was the polyp (2mm) and that the back part (approximately 1cm) was normal tissue, not a polyp.
However, since the biopsy results indicated moderate dysplasia, I am concerned that if that is indeed part of the polyp and it was not completely removed, it could pose a problem.
Therefore, I sought consultation at a hospital.
The hospital physician reviewed the report and said it is difficult to determine whether the protruding area is part of the polyp (as I had a colonoscopy two years ago, which did not reveal any polyps).
He mentioned that if that is indeed part of the polyp and it was not completely removed, it could be dangerous.
He suggested scheduling another colonoscopy for peace of mind.
1.
Is it safe to undergo another colonoscopy just two weeks after the last one? (Considering that tissue and polyps were removed last time, there are wounds, which may increase the risk of bowel perforation?)
2.
If there are wounds found during the procedure and they have not healed, could this lead to a misjudgment by the physician?
3.
If I need to wait for the wounds to heal before undergoing another colonoscopy, how long should I wait for the wounds to heal, and what is an appropriate interval for rescheduling the procedure?
4.
Since my father has colon cancer, if I have adenomatous polyps at my age, how often should I be monitored in the future?
5.
Should my siblings also undergo colonoscopy screening?
Thank you, and I wish you good health.

wu, 20~29 year old female. Ask Date: 2017/07/20

Dr. Cai Anshun reply Gastroenterology and Hepatology

Hello: 1.
This type of polypectomy wound does not increase the risk of bowel perforation.
2.
There may be difficulty in distinguishing the base.
3.
If the physician recommends another colonoscopy, it can be performed after more than 4 weeks.
4.
Depending on the size of the adenoma, larger ones should be monitored annually, while smaller ones every three years.
5.
For individuals over 40 years old, screening is recommended, or 10 years younger than the age of onset.
Changhua Hospital cares about your health.
Dr.
Tsai An-Shun.

Reply Date: 2017/07/20

More Info

Understanding the need for a repeat colonoscopy, especially in the context of previous findings such as adenomatous polyps, is crucial for ensuring your health and addressing any potential risks. Given your situation, let’s break down your concerns and provide detailed insights.

1. Timing for Repeat Colonoscopy: Performing a repeat colonoscopy just two weeks after the initial procedure is generally acceptable, but it does come with considerations. The risk of perforation (a serious complication where the colon wall is punctured) is typically low, especially if the first procedure was uncomplicated. However, since tissue was removed, there may be some residual healing that could slightly increase this risk. Most guidelines suggest waiting at least a few weeks to allow for adequate healing, but if your physician believes that the benefits of a repeat procedure outweigh the risks, it may be warranted.

2. Assessment of Healing: If there are visible signs of healing or if the physician is aware of the previous biopsy sites, they can make informed decisions during the repeat colonoscopy. However, if the healing is incomplete, it may complicate the procedure. The physician may need to be cautious to avoid exacerbating any existing wounds. This is why clear communication with your healthcare provider about your concerns and their assessment of your healing is essential.

3. Healing Time: The healing time for the colon after a polypectomy can vary, but generally, it is recommended to wait at least 4-6 weeks before undergoing another colonoscopy. This allows the tissue to heal adequately and reduces the risk of complications. Your healthcare provider will be the best judge of your specific situation, so following their advice is crucial.

4. Follow-Up for Adenomatous Polyps: Given your family history of colon cancer and the presence of adenomatous polyps, follow-up surveillance is critical. The general recommendation for individuals with a history of adenomatous polyps is to have a repeat colonoscopy in 3 years if the polyps were small and low-risk. However, if there are more significant findings or if there is a family history of colorectal cancer, your physician may recommend more frequent surveillance, potentially every 1-2 years.

5. Family Screening: Since your father had colon cancer, it is advisable for your siblings to undergo screening as well. The general recommendation is that individuals with a family history of colorectal cancer should start screening 10 years before the age at which the affected family member was diagnosed or at age 40, whichever comes first. This proactive approach can help catch any potential issues early.

In summary, while the need for a repeat colonoscopy shortly after the initial procedure can be concerning, it is often necessary for thorough evaluation and peace of mind, especially in the context of your findings. Always consult with your healthcare provider to discuss your specific risks, the timing of the procedure, and the appropriate follow-up care based on your personal and family medical history. Your health and well-being are paramount, and staying informed and engaged with your healthcare team is the best approach to managing your health.

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