What is the recommended timing for a colonoscopy in a 62-year-old patient with a history of ascending cholangitis (inflammation of the bile duct), treated 5 years ago without complications?

From the Guidelines

For a 62-year-old individual with a history of ascending cholangitis 5 years ago that was treated without complications, colonoscopy screening should be performed every 10 years if they haven't had one recently, as recommended by the U.S. multi-society task force on colorectal cancer 1. The general recommendation for average-risk individuals is to begin colorectal cancer screening at age 45 and continue until age 75, with colonoscopy typically performed every 10 years if results are normal. This patient's history of ascending cholangitis does not directly affect colonoscopy timing, as it involves a different part of the gastrointestinal system. Some key points to consider for colonoscopy screening include:

• High-quality colonoscopy every 10 years or an annual FIT as first-tier options for screening of colorectal neoplasia 1
• Flexible sigmoidoscopy every 5 to 10 years, CT colonography every 5 years, or FIT–fecal DNA every 3 years in individuals who decline colonoscopy and a FIT 1
• Capsule colonoscopy (if available) is an appropriate screening test every 5 years when individuals decline colonoscopy, FIT, FIT–fecal DNA, CT colonography, and flexible sigmoidoscopy 1 However, if the patient had any concerning gastrointestinal symptoms like rectal bleeding, change in bowel habits, unexplained weight loss, or abdominal pain, colonoscopy might be indicated sooner regardless of screening intervals. Prior to the procedure, the patient will need to complete a bowel preparation regimen, typically involving clear liquids for 24 hours and a prescribed laxative solution. This screening is important because colorectal cancer is often preventable through the removal of precancerous polyps, and when detected early, has excellent treatment outcomes, thus reducing morbidity, mortality, and improving quality of life 1.

From the Research

Colonoscopy Screening Guidelines

• The American College of Gastroenterology recommends colorectal cancer (CRC) screening for average-risk individuals, with detailed guidelines discussed in the 2021 update 2.
• The guidelines aim to optimize CRC screening, allowing for effective and sustained reduction of CRC incidence and mortality.

Patient Understanding and Informed Consent

• A study found that patients scheduled for screening colonoscopy have limited knowledge of its risks and alternatives, with subjects with lower education levels and lower income having even less understanding 3.
• The quality of informed consent may be low for patients who do not receive additional information until they have begun the preparation for the test.

Colonoscopy in Older Adults

• A retrospective study compared the performance and safety of diagnostic colonoscopy in nonagenarians (90 years or older) with patients who were 75 to 79 years old, finding increased risk for incomplete procedure, inadequate bowel preparation, and adverse events in the older group 4.
• However, a large proportion of nonagenarians were found to have advanced neoplasia and cancer, compared with patients 75 to 79 years old.

Bowel Preparation and Colonoscopy

• Inadequate bowel preparations still occur in 10-25% of colonoscopies, leading to increased procedural times, lower cecal intubation rates, and shorter interval between colonoscopies 5.
• Recent advances in bowel preparation aim to improve tolerability, compliance, and preparation quality, including newer, lower volume, flavored preparations and the use of adjuncts.

Recommendations for the Patient

• Given the patient's history of ascending cholangitis 5 years ago, it is essential to consider the risks and benefits of colonoscopy, as well as the patient's overall health and medical history.
• The patient should discuss their individual risk factors and medical history with their healthcare provider to determine the best approach for colonoscopy screening, taking into account the guidelines and recommendations from studies such as 2 and 4.