Who needs a colonoscopy?

Everybody needs a colonoscopy at some point in their adult life! Did you know that Singaporeans have a 5% lifetime risk of developing cancer? This risk increases as we age! As with any cancer, the outcome or prognosis is better when it is detected at an early stage. With regular colonoscopy, we have the ability to survey the colon for early cancers and biopsy them before an actual surgery. Better still, the detection of polyps during colonoscopy enables the problem to be ‘nipped in the bud’ (literally!). This is because colorectal cancers are thought to originate as small polyps that eventually undergo malignant transformation into cancers.

Do I need a regular scope check-up? How often should I do it?

The Health Promotion Board recommends a screening colonoscopy for everyone above the age of 50. Any individual who has a first-degree relative with a history of colon cancer, the recommendation is to do a colonoscopy 10 years prior to that index case.

Beyond the first screening colonoscopy, the frequency is dictated by:
– Presence of symptoms such as bleeding in the stools, change in bowel frequency or consistency.
– Presence of polyps (type, size & number) found in the previous scope.

It’s good to have a discussion with your surgeon about the need for a colonoscopy and how often to repeat it.

Senior Citizens

What can it do for me? Treat cancer?

Colonoscopy is the best way to detect polyps and cancers. Scans such as CT colonography and barium enema may not be sensitive enough to pick up tiny polyps. Through a scope, a surgeon can both view and biopsy (take a sample) for histology. This is crucial for confirming the diagnosis before an actual resection surgery is recommended.

Other than diagnosis, the colonoscope may sometimes be used to treat rectal cancer when it is at its earliest stage (T1). This is feasible via a highly specialised technique known as endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD). Not every early cancer is suitable for this endoscopic resection though.

Can I request for this procedure for a peace of mind?

There are many reasons why an individual may request for a colonoscopy even though he may not have any symptoms. The commonest reason is a positive family history of polyps and/or colonic cancer. Ultimately, whatever the reason, a normal colonoscopy can certainly provide a peace of mind. Nevertheless, a colonoscopy is not without risks so be sure to discuss all the potential risks and benefits with your surgeon.
Patient discussing colonoscopy with surgeon

Is it a common procedure in Singapore?

It is one of the commonest procedure being performed amongst Singaporeans. This is in part due to an effective public health campaign towards awareness of colorectal cancer. I’m sure that amongst your relatives, friends and colleagues, there will be at least a couple of them who have undergone a colonoscopy. As mentioned earlier, some people do need to have a repeat colonoscopy because of abnormal findings or the emergence of new symptoms.

Is this a surgery? Will it be covered by insurance?

With operative techniques such as laparoscopic or endoscopic surgery, modern-day surgery has departed from the concept of always needing to cut open a body part to fix or remove a problem. Colonoscopy and endoscopy in general do not fit under this traditional approach. Nevertheless, a surgical code and table are assigned to colonoscopy just like other surgical procedures. This enables all procedures to be audited by the Health ministry as well as providing a fee benchmark. Surgical procedures are covered by government subsidies as well as both national and private insurance.

I hear it is a very uncomfortable procedure. Can I be under GA?

A colonoscopy is usually performed either under conscious or deep sedation. An anaesthetist may be present to assist with this sedation. Rarely is a general anaesthesia (GA) necessary which means the complete loss of the patient’s protective reflexes and ability to maintain his airway. Depending on the level of sedation, the patient may have some awareness of discomfort (such as abdominal bloating) during the procedure. Generally, this discomfort is minimal and should dissipate completely at the end of the procedure.

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