The Colonoscopy: A Historical Timeline

As we approach the end of this year’s Colorectal Cancer Awareness Month, let’s take a closer look at something near and dear to our hearts: the colonoscopy. 

As the only screening test that detects and prevents cancer, the best test for finding precancerous polyps, and the only test recommended for people with risk factors such as personal history of polyps or cancer, the colonoscopy is truly a life-saving resource. Over 15 million colonoscopies are performed across the United States each year, reducing the widespread risk of colorectal cancer death by over 60%.

However, despite the colonoscopy’s widespread use and unequivocal standard of effectiveness, it is actually a fairly new methodology, one that took decades to be widely-known and well-established. While variations of the colonoscopy were first conceptualized throughout the 1960s, it wasn’t until the last few decades that the standards of quality which govern the colonoscopy as we know it came to be.

Follow along for a deep-dive into our favorite colorectal cancer screening test. 

1960s-70s: The Early Years

Up until the mid-1960s, the closest thing to a colonoscopy was an endoscopic procedure using a rigid sigmoidoscope. This device had very limited movement, reach, and was unable to actually remove polyps. 

In 1969, colleagues Dr. William Wolff and Dr. Hiromi Shinya of Beth Israel Medical Center in New York City invented the fiberoptic colonoscope, the first device to allow doctors to actually examine the entire length of the colon, thanks to its flexible, dynamic design.

Dr. Shinya also invented the polypectomy snare in 1969, a device which was able to physically remove colorectal polyps using a wire and electro-cauterizing mechanism. 

By 1973, the pair had performed over 5,000 colonoscopies, demonstrating the validity and safety of the procedure. 

1980s-90s: Increasing Awareness

In 1983, the Welch Allyn Corporation invented the first video endoscope, allowing doctors to see the procedure on-screen. Before, they were only able to observe the colon through a small eyepiece. 

Although the colonoscopy continued to develop, there was still a lack of general public accessibility and awareness towards the procedure. Many people opted for tests such as fecal occult blood testing and sigmoidoscopy. It wasn’t until 1985, when President Ronald Reagan underwent a life-saving colonoscopy, that the procedure began to garner national attention. 

In the mid-90s, the first screening recommendations were established in the United States. Adults over the age of 50 were suggested to receive regular colonoscopies. However, in a 1999 survey conducted by the CDC, only 40.3% of American adults over the age of 50 reported ever having a colonoscopy or sigmoidoscopy.  

2000-Now: New Developments

In 2000, the American Society for Gastrointestinal Endoscopy (ASGE) published the first colonoscopy guidelines. This seminal work allowed the quality of a colonoscopy to be measured with a numeric value, the Adenoma Detection Rate (ADR) as well as evaluate measures such as the quality of bowel preparation, patient assessments, rate of complications, cecal intubation rate, and withdrawal time. Doctors were finally able to be pragmatically evaluated for their ability to perform a colonoscopy. 

The early 21st century saw a significant increase in colonoscopies. Self-reported colonoscopies across the United States increased from 20% in 2000 to 47% in 2008. This can be contributed to many factors: a variety of educational campaigns and visibility measures pushed by doctors, government, and public organizations; Medicare coverage of colonoscopy, beginning in 2001; even celebrity stunts such as the Today Show’s Katie Couric’s publicized colonoscopy.

From 2000 to 2015, colon cancer rates rose considerably across increasingly younger populations. For adults aged 40-44, colorectal cancer incidence increased by 28%, for those aged 45-49, colorectal cancer increased by 15%, and while colonoscopy rates increased 17% in those aged 50–54. 

Rising colorectal cancer rates have led to efforts such as the U.S. Preventive Services Task Force’s 2020 recommendation that all adults aged 45-75 should be regularly screened. This was an update from the 2016 guidelines that suggested adults without risk factors should begin screening at the age of 50.

What is the future of the colonoscopy?

The colonoscope of the present remains largely unchanged from that first created by Dr. Wolff and Shinya in 1969. While it has developed in mechanical quality, such as flexibility and control, and now features a light source, suction device, lens cleaning, and a camera, it doesn’t really vary in its fundamental use: to observe and remove colorectal polyps, acting as both a diagnostic and therapeutic instrument. Why is this the case? Likely because it is highly effective at what it does! 

With this in mind, the most important development concerning colonoscopies, arguably, is in the public sphere. While the mechanisms of the procedure itself will undoubtedly continue to evolve and innovate, it’s important to consider the future of public access and opinion towards the colonoscopy.

There is still a surprising amount of misconception surrounding the colonoscopy. A 2020 survey of several European countries found that only 45% of people understood that it can prevent colon cancer. In the United States (pre-pandemic), around 68.8% of adults were up-to-date with their colonoscopy. Many people remain uninformed, fearful, and resistant to receiving the  life-saving screening test. Other people are limited by financial means or geographic accessibility to the procedure. 

By working to increase public awareness around the value of the colonoscopy, we can continue to prevent and reduce colorectal cancer deaths around the world. By educating your friends and loved ones about the importance of colonoscopy, partaking in events such as #DressInBlueDay and National Colorectal Cancer Awareness Month, getting involved with organizations like the Colon Cancer Coalition, and getting screened, yourself, you can help promote widespread change. 

See new infographics created by the Digestive Health Physicians Association below. To read stories about people’s experiences with colonoscopies and colorectal cancer, click here. To see our favorite online resources for promoting awareness, click here. To learn more about what exactly colorectal cancer is, click here.

The colonoscopy a historical timelineColorectal screening tests

An Overview of Colorectal Cancer Screening Tests

March is National Colorectal Cancer Awareness Month, an important time to spread awareness and learn more about the risks associated with colorectal cancer.

Colorectal cancer is one of the most common forms of cancer and the second-leading cause of cancer deaths in the world. In the United States this year, an estimated 151,030 adults will be diagnosed with colorectal cancer and ​​an estimated 52,580 will die from the disease. 

Despite its significant rate of incidence, colorectal cancer is highly preventable through the use of screening tests. Gastroenterology Health Partners, in conjunction with the American Cancer Society and Digestive Health Partners Association, recommends that those with an average risk start screenings at age 45. 

Of the colorectal cancer screening tests that we offer, colonoscopy remains the gold-standard of effectiveness and is strongly suggested for anyone eligible. Observational studies have suggested that colonoscopy can reduce colorectal cancer occurrence by 40% and mortality rates by 60%. 

If you’re considering scheduling a screening test, talk to an experienced gastroenterologist. They can help you make the right decision for your needs. 

Keep reading to learn about six commonly-offered colorectal cancer screening tests.

6 Common Colorectal Cancer Screening Tests

1. Colonoscopy

As mentioned above, the colonoscopy is the best diagnostic tool available. This out-patient procedure involves the use of a thin, flexible tube with a camera to exam the lining of the colon (large intestine) for abnormalities such as polyps. Some polyps can be removed with a scope during the procedure. Your doctor may also take tissue samples for analysis as well.

While the colonoscopy does require prep and recovery time, it is a fast, virtually risk-free procedure. Afterwards, your doctor will discuss your results with you and recommend whether you should be screened in 1, 5, or 10 years. To learn more about the colonoscopy, how it works, how to prepare, and more, read here

2. Fecal immunochemical test (FIT)

Often considered the second choice after a colonoscopy, the fecal immunochemical test (FIT) offers a non-invasive method for identifying colorectal cancer. The test, often performed at home, tests for hidden (occult) blood in the stool. This unnoticeable blood is often an early-sign of colorectal cancer. 

If you test positive for hidden blood during a FIT test, your doctor will want to perform another test, most likely a colonoscopy. FIT, unlike colonoscopy, is unable to actually identify or remove polyps and abnormal tissue. Therefore, the FIT is not really a viable “preventative” test and has a much lower accuracy rate. 

3. CT Colonography

The CT Colonography is also known as a “virtual colonoscopy.” This test uses a CT scan (a form of x-ray technology) to exam the colon for polyps. A small scope is inserted slightly into the colon to inflate it with air. Then, pictures are taken of the entire colon. The CT Colonography is highly effective, and, unlike a colonoscopy, it doesn’t require sedation. However, unlike a colonoscopy, this exam doesn’t actually remove precancerous polyps, it only can identify them.

4. Cologuard

Cologuard is another non-invasive, at-home colon screening test. Much like the FIT test, it looks at stool DNA samples. While Cologuard is generally more effective than FIT, it still doesn’t compare to the effectiveness of the colonoscopy–while colonoscopy is known to identify over 70% of precancerous polyps, Cologuard only identifies around 42%.

5. Flexible Sigmoidoscopy

A flexible sigmoidoscopy is a comparable procedure to the colonoscopy. It is an exam of the lower part of the colon using a small, flexible, lighted tube. The tube, called a flexible sigmoidoscope, has a camera which allows the doctor to view the inside of the rectum and the sigmoid colon—about the last two feet of the large intestine. Unlike a colonoscopy, this procedure does not allow the doctor to see the entire colon; any cancers or polyps far in the colon cannot be detected. 

6. Capsule Endoscopy

A capsule endoscopy is a procedure that examines the lining of the middle part of the small intestine, the duodenum, jejunum and ileum. This procedure is necessary because a standard endoscope or colonoscope cannot reach this part of the bowel. Capsule endoscopy is often used to search for causes of bleeding as well as detect polyps, tumors, ulcers, and IBD.

During this procedure, the patient will swallow a tiny pill containing a video camera, light source, and battery. The camera will take 2-3 pictures per second for up to 12 hours, traveling through the GI tract. The photos are saved automatically to a recording device and strung into a video. 

While capsule endoscopy is effective for detecting and documenting significant lesions attributed to conditions such as IBD, tumors, and ulcers, it is significantly less effective as a colon screening test compared to colonoscopy. 

 When it comes to colon cancer screenings, the experienced medical team at Gastroenterology Health Partners is here to serve you. To learn more about our services or to schedule an appointment at one of our offices in Southern Indiana or Kentucky, contact a Gastroenterology Health Partners location near you.

Managing GERD Through Diet: Foods To Seek Out and To Avoid

We’ve all felt it after eating–that burning, uncomfortable feeling in the chest. Maybe you know it as heartburn, indigestion, or acid reflux. While just about everyone experiences this sensation once in a while, there’s actually a significant number of people who suffer from it often. In fact, about 20% of the United States population experiences symptoms of chronic acid reflux, also known as gastroesophageal reflux disease (GERD). Besides being unpleasant and frustrating, GERD can lead to serious complications such as esophagitis or Barret’s esophagus

At this time, there is not a singular commonly-recognized cause of GERD. While some research associates it with obesity, smoking, certain medications, being pregnant, or genetic predisposition, it can really happen to anyone. Symptoms, besides heartburn, include nausea, pain or difficulty swallowing, regurgitation (when gastric contents re-enter the mouth or throat), burping, and a chronic cough. Symptoms of more serious complications from GERD can include loss of appetite, vomiting, blood in vomit or stool, increased pain or difficulty when swallowing, asthma, poor sleep, and weight loss. 

Common Treatments for Gastroesophageal Reflux Disease (GERD)

If you’re diagnosed with GERD, you do have options for treatment. There are a variety of recommended over-the-counter and prescription medications that can neutralize or reduce stomach acid production. For those who wish to avoid long-term medication use, there are surgical options available as well.

Making certain lifestyle and dietary changes are considered essential to reduce symptoms of GERD. Slowing down the speed of eating, avoiding lying down right after eating, keeping your head elevated in bed, and avoiding tight clothes that put pressure on your chest or stomach are all said to improve symptoms for some. 

Foods To Limit Or Avoid If You Are Experiencing GERD

There are certain foods that are recommended for you to avoid if you have GERD. These foods can trigger or worsen symptoms of the disease. These include:

  • Tomatoes
  • Caffeine
  • Acidic fruits, like oranges, lemons, and limes
  • Spicy foods
  • Mint
  • Chocolate
  • Onion
  • Alcohol
  • Carbonated drinks
  • Garlic
  • High-sugar or high-fat foods
  • Fried or processed foods
  • Lactose, if you are lactose-intolerant

Foods To Incorporate Into Your Diet If You Are Experiencing GERD

On the other hand, there are certain foods that are often “safer” to consume for those experiencing GERD. These can include:

  • Non-citrus fruits, like apples, bananas, or melons
  • Oatmeal, brown rice, and whole grains
  • Root vegetables like potatoes or turnips
  • Water-dense vegetables like cucumber or celery
  • Low-acidic vegetables
  • Water and tea
  • Lean meats or fish

Of course, each person’s experience with acid reflux and GERD is unique. Foods affect each of us differently, so it’s important to monitor how you feel after consuming certain meals. Keeping a journal or notes tab on your phone of what “triggers” your symptoms can be a useful tool for you and your doctor. If you experience symptoms of GERD, the most important thing is to seek medical care–don’t self-diagnose or try to manage symptoms on your own. 

If you are suffering from chronic gastroesophageal reflux disease, the experienced team at Gastroenterology Health Partners is here for you. Our clinicians have a passion for seeking out and refining new treatments and advanced solutions for those suffering from disorders of the digestive system. For more information or to schedule a gastroenterological medical evaluation, contact a Gastro Health Partners location near you.