No colonoscopy unless the benefits outweigh the risks

Patients should only undertake a colonoscopy if the benefits outweigh the risks, according to a new national agreed standard of care.

Despite being frequently performed (almost one million Australians have the procedure per annumⁱ), colonoscopy is a complex medical procedure, so undergoing the procedure unnecessarily doesn’t make sense and may extend the wait time for those who do need it.

The new Colonoscopy Clinical Care Standard, launched by the Australian Commission on Safety and Quality in Health Care, says patients with a positive bowel cancer screening result should consult their general practitioner to discuss further investigation. In many cases this will be a colonoscopy. The procedure examines the large bowel (colon) to diagnose and treat a range of bowel diseases including bowel cancer, the second most common cancer diagnosed in both men and women in Australia. Bowel cancer is expected to claim more than 4000 lives in Australia in 2018.ⁱⁱ

Commission Clinical Director Professor Anne Duggan said the new standard offers guidance to patients, clinicians and health services at each stage of a colonoscopy, with the goal of ensuring high-quality and timely colonoscopies for patients who need them. The standard will also help to reduce the number of unnecessary colonoscopies being carried out.

“The commission’s Australian Atlas of Healthcare Variation 2015 found stark differences across the country in rates of colonoscopies being performed, with some areas having colonoscopy rates 30 times higher than others,” said Professor Duggan.

“We asked experts in colonoscopy about how to look after people in the best possible way and used this information to develop guidelines for everyone involved.”

Gastroenterological Society of Australia (GESA) spokesperson Dr Iain Skinner is a colorectal surgeon and advanced colonoscopist who co-chaired the commission’s working group that developed the new standard. He said the guidelines were much needed.

“The clinical care standard further enhances care, focusing on bowel preparation, sedation, the colonoscopy and recovery. The standard also clarifies appropriate use of the procedure based on evidence,” said Dr Skinner.

The Colonoscopy Clinical Care Standard was also developed with the input of consumers and contains advice and information designed to inform colonoscopy patients and their families on shared decision-making so that they can be an active participant in their care delivery.

Susan Morris has Lynch syndrome, a hereditary cancer risk associated with bowel and 11 other cancers. She has undergone annual colonoscopies since she was first diagnosed in 2012.

“In my experience, and speaking to many others like me who need to have regular colonoscopies, it is really important to know you are receiving high-quality care at all stages.

“The clinical care standard will ensure you really understand all aspects of your care, both before and after colonoscopy, and means that you can help make decisions about your care.

The Colonoscopy Clinical Care Standard and separate fact sheets for consumers and clinicians are available on the commission’s website.