New guidelines set to reduce number of colonoscopies in Australia

While thousands of people across Australia undergo colonoscopies each year, a new national standard could reduce the number of unnecessary colonoscopies endured by those who could go without.

In a first for Australia, the new nationally agreed standard of care for patients who undergo the procedure will only be offered if the benefits outweigh the risks. The number of Australian colonoscopies is fast approaching one million annually, with experts warning it doesn’t make sense for people to undergo the complex procedure unless they really need it.

The new Colonoscopy Clinical Care Standard was launched on Monday by the Australian Commission on Safety and Quality in Health Care and said patients with a positive bowel cancer screening result should consult their GP for further investigation.

The colonoscopy procedure typically examines the large bowel or colon to diagnose and treat a variety of different diseases such as bowel cancer. The purpose of the new standard is to provide patients, clinicians and health services with guidance at each step of a colonoscopy to ensure high-quality and timely colonoscopies for patients who need them, while also reducing the number of unnecessary colonoscopies being carried out.

“The Commission’s Australian Atlas of Healthcare Variation 2015 found stark differences across the country in rates of colonoscopies being performed, with some areas having colonoscopy rates 30 times higher than others,” Commission Clinical Director Professor Anne Duggan said.

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Research found that colonoscopy rates were significantly higher in capital cities, but lower in remote areas. In the major cities, rates were lower in areas of low socioeconomic status.

“The clinical care standard supports clinician certification and recertification as requirements for colonoscopy services, and will bring increased rigour to the procedure and shine a light on when and how these procedures are done,” Duggan said. “We asked experts in colonoscopy about how to look after people in the best possible way and used this information to develop guidelines for everyone involved.”

The move has been welcomed across the board, with many claiming the new guidelines were much needed.

“The clinical care standard further enhances care, focusing on bowel preparation, sedation, the colonoscopy and recovery,” Gastroenterological Society of Australia spokesperson Dr Iain Skinner said. “The standard also clarifies appropriate use of the procedure based on evidence. This is an advanced procedure and we don’t want it being performed unnecessarily.”

He added that fewer unnecessary colonoscopies will free up access to more timely colonoscopies for those who are at moderate or high risk. This could include patients with a family history of bowel cancer, those with polyps or patients who return a positive bowel screening test.

His calls were echoed by patient Susan Morris. Morris has Lynch syndrome, a genetic condition linked to 11 different cancers, including bowel cancer. As part of her management, she’s required to undergo a colonoscopy each year.

“In my experience, and speaking to many others like me who need to have regular colonoscopies, it is really important to know you are receiving high-quality care at all stages,” Morris said. “The clinical care standard will ensure you really understand all aspects of your care, both before and after colonoscopy, and means that you can help make decisions about your care.”

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The new standard has been endorsed by an array of professional bodies.

“It is pleasing to have these professional bodies associated with colonoscopy actively adopt the standard, as well as to have it supported by the Cancer Council, and consumer representatives such as Lynch Syndrome Australia,” Duggan added. “When undergoing a colonoscopy, it is incredibly important that it is safe and appropriate for the patient.

“For this to happen, the individual needs to understand the procedure and what is expected from them at each stage.”

Have you ever had a colonoscopy? What was the experience like for you?