Table 1.

Guidelines for Modified Colon Endoscopy

Primary indications:

  • Screening for colorectal cancer in asymptomatic patients according to ACS guidelines

  • Rescreening of patients with history of treated colon cancer

    • –Known familial colon cancer history

  • Diagnostic examinations:

    • –Evaluation of positive FOBT

    • –Evaluation of rectal bleeding

    • –Evaluation of change in bowel habits

    • –Follow-up of selected patients previously found to have benign lesions

Contraindications:

  • Multiple previous abdominal surgical procedures

  • Known active inflammatory bowel disease or diverticulitis

  • Inability to complete or tolerate bowel prep

  • Inability to cooperate because of mental illness, dementia or disability

Reasons to terminate procedure and refer to consultant endoscopist:

  • Inability to advance endoscope with reasonable effort and within reasonable time

  • Excessive patient discomfort

  • Extensive diverticulosis with inability to identify lumen

  • Discovery of active inflammatory bowel disease or diverticulitis

  • Discovery of multiple lesions that will require extensive polypectomy

  • Discovery of obstructing lesion

  • Discovery of obvious cancer

  • Visual recognition of incompletely removed dysplastic lesion

Lesions to biopsy using biopsy forceps:

  • All polyps

  • Most abnormal mucosa

Lesions to NOT biopsy using biopsy forceps:

  • Diverticuli (perforation risk)

  • Flat lesions within diverticuli (perforation risk)

Lesions to remove with snare:

  • Pedunculated polyps

Lesions to NOT remove with snare:

  • Broad-based polyps (perforation risk)

  • Lesions within diverticuli (perforation risk)