Colonoscopy, Upper Endoscopy, and Sigmoidoscopy may be scheduled for stable persons with specific accepted indications. Exclusion criteria for this program are also included, along with a list of other relevant information.

Colonoscopy indications include:

1. Colon cancer screening/polyp surveillance

Current guidelines for screening
- Average risk man or woman (every 10 years starting at age 50)
- Family history of colon cancer or polyps:

• 2 or more 1st degree relatives or one 1st degree relative affected at age younger than 60 years (every 5 years starting at age 40 or 10 years earlier than youngest diagnosis in family, whichever is first)
• 1st degree relative at age younger than 60 years (Average risk screening but beginning at age 40 years)
• HNPCC or FAP (genetic counseling & special screening)

Current guidelines for surveillance
- Advanced or multiple ( >3) adenomas: every 3 years
- 1 or 2 small (<1 cm) adenomas: every 5 years
- Personal history of colon cancer: 3 years; then if normal, every 5 years

2. Bleeding

• Unexplained iron deficiency
• Positive fecal blood test
• Rectal bleeding

3. Unexplained chronic diarrhea (longer than 3 weeks duration)

4. Inflammatory bowel disease (patient should have GI follow-up)

• Ulcerative pancolitis or Crohn's colitis for longer than 8 years or left-sided ulcerative colitis for longer than 15 years (repeat every 1 to 2 years)

5. Unexplained weight loss

Upper Endoscopy (EGD) indications include:

• Persistent symptoms of gastroesophageal reflux disease (GERD)
• Persistent dyspepsia
• Dysphagia
• Nausea/vomiting
• Iron deficiency anemia/ melena
• Rule out or follow-up Barrett esophagus
• Unexplained weight loss

Sigmoidoscopy indications include:

• Rectal bleeding
• Rectal pain or tenesmus
• Fecal incontinence
• Unexplained diarrhea
• Colon cancer screening (insurance does not cover colonoscopy or patient prefers sigmoidoscopy)
  

EXCLUSION CRITERIA for Direct Access Endoscopy

Patient MUST be seen in the Gastroenterology Clinic or contact the endoscopist if any of the following apply:

• Age older than 80 years
• Weight greater than 350 pounds
• Pregnancy
• General anesthesia required
• Patient unable to perform consent
• Artificial heart valve
• Chronic obstructive pulmonary disease (COPD) (forced expiratory volume (FEV) 1 < 1.0)
• Myocardial infarction/angina/severe congestive heart failure for less than 6 months
• Anemia with hematocrit less than 20%
• Coagulopathy/anticoagulation test (international normalized ratio [INR] > 1.5, platelets < 75 K, coumadin, heparin)

Other relevant information:

• Diabetic patient
• Antibiotic prophylaxis concern
• ASA/NSAID/Plavix use - if clinically safe hold for 1 week prior to procedure
• Automatic implanted cardiac defibrillator (ICD) - must be turned off/on in MPU peri-procedure.
  ICD manufacturer:_________________________________