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Colonoscopy practice in the UK today: are we adequately prepared for national colorectal cancer screening tomorrow?
In the West, 5% of individuals will at some time in their life develop colon cancer, and after the age of 54 years the risk lies between 1 in 19 to 1 in 22.12 There is increasing pressure to develop colon screening programmes to identify early tumours and adenomatous polyps whose endoscopic removal has been shown to reduce cancer development.34 Colon cancer screening is likely to be funded in England and in Scotland, and whether this is based on faecal occult blood testing,56 flexible sigmoidoscopy,7 or colonoscopy alone,89 and whether or not programmes will be targeted towards high risk groups or to all comers over a specific age, it is obvious that referrals for colonoscopy will increase. At the same time, there is increasing awareness among the general population and in primary care that rectal bleeding and altered bowel habit need investigation, ideally by colonoscopy. Most endoscopy units in the UK have difficulty coping with their current workload, and strains on the colonoscopy waiting list will inevitably increase when screening programmes are instigated.
Series published from the USA have reported success rates in excess of 97% for achieving total colonoscopy, coupled with low complication rates, and detection of significant pathology in asymptomatic populations.810 Specialist centres in the UK report comparable data and have shown that it is possible to undertake safe diagnostic and therapeutic colonoscopy using minimal sedation, little patient discomfort, and low complication rates. The Joint Advisory Group on Gastrointestinal Endoscopy (JAG) state that approved endoscopy units should achieve completion rates greater than 90%, without resort to excessive sedation. The current curriculum for higher medical training in gastroenterology suggests that …
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