When should a 62-year-old with a history of ascending cholangitis, treated with Endoscopic Retrograde Cholangiopancreatography (ERCP) 5 years ago, undergo a colonoscopy?

From the Guidelines

A 62-year-old individual with a history of ascending cholangitis treated with ERCP 5 years ago without complications should undergo colonoscopy screening if they haven't had one recently, as 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 1. The history of ascending cholangitis and ERCP does not directly impact colonoscopy timing, as these conditions affect the biliary system rather than the colon.

• Key considerations for colonoscopy screening include:
  • Age: The patient is 62 years old, which falls within the recommended screening age range of 50-75 years for average-risk individuals 1.
  • Risk factors: There is no mention of family history or other risk factors that would necessitate earlier or more frequent screening.
  • Symptoms: If the patient had any symptoms suggestive of colorectal issues (such as rectal bleeding, change in bowel habits, unexplained weight loss), colonoscopy would be indicated regardless of screening intervals. Prior to the procedure, the patient will need to complete a bowel preparation regimen, typically involving clear liquids the day before and a prescribed laxative solution.
• The importance of screening is highlighted by the fact that colorectal cancer is preventable through the removal of precancerous polyps during colonoscopy, as recommended by the American College of Gastroenterology, 2021, and the US Preventive Services Task Force, 2021 1. Given the patient's age and lack of reported risk factors or symptoms, the most appropriate course of action is to follow the general recommendation for average-risk individuals and undergo colonoscopy screening if they haven't had one recently, with a repeat screening every 10 years as recommended by the American College of Gastroenterology, 2021 1.

From the Research

Colonoscopy Screening Guidelines

The patient in question is 62 years old with a history of ascending cholangitis treated with ERCP 5 years ago. To determine when the patient should undergo a colonoscopy, we can look at the following guidelines:

• The American College of Gastroenterology recommends that adults with an average risk of colorectal cancer undergo screening colonoscopy every 10 years, starting at age 50 2.
• However, the patient's history of ascending cholangitis may not directly influence the recommendation for colonoscopy screening, as the primary concern is the risk of colorectal cancer.
• Studies have shown that colonoscopy is superior to other screening methods, such as fecal occult blood tests (FOBT) and sigmoidoscopy, in detecting colorectal neoplasms 3, 2, 4.

Screening Methods and Effectiveness

The effectiveness of different screening methods is as follows:

• FOBT has a relatively low sensitivity for detecting advanced colonic neoplasms, with a sensitivity of 20.2% to 48.3% for advanced neoplasms and 37.5% to 87.5% for cancers 2, 5.
• Sigmoidoscopy can detect 70.3% to 75.8% of advanced neoplasms, but may miss lesions in the proximal colon 2, 4.
• Colonoscopy is the most effective method for detecting colorectal neoplasms, with a sensitivity of 93.8% for advanced neoplasms and 95.8% for cancers 2.

Recommendations for the Patient

Based on the guidelines and evidence, the patient should undergo a screening colonoscopy every 10 years, starting at age 50. Since the patient is already 62 years old, it is recommended that they undergo a colonoscopy as soon as possible, and then repeat the screening every 10 years thereafter. The patient's history of ascending cholangitis does not appear to affect the recommendation for colonoscopy screening.

• Key factors to consider for the patient's colonoscopy include:
  • Bowel preparation: The patient should be informed about the importance of adequate bowel preparation to ensure a successful colonoscopy 6.
  • Screening interval: The patient should undergo a colonoscopy every 10 years, or as recommended by their healthcare provider.
  • Risk factors: The patient's healthcare provider should assess their individual risk factors for colorectal cancer and adjust the screening interval accordingly.