A CMH Community DocTalk with

Robert Wayne, MD, FACS

My BackgroundMy Background

• Board Certified General Surgeon in Astoria for 30 years• Performing endoscopies since starting practice in 1978• Membership in the Society of American Gastroentestinal

and Endoscopic Surgeons (S.A.G.E.S.)• Attended numerous lectures and updates on endoscopy• Personal experience with my own 3 colonoscopies

What is a Colonoscopy?What is a Colonoscopy?

• Examination of the lower intestine• Using a 5 foot fiber optic flexible telescope• Done in an outpatient setting• Using conscious sedation (strong amnesia)• Average time varies from 20 to 60 minutes• Diagnostic and therapeutic exam• Biopsies and removal of polyps can be done

The ColonThe Colon

The ColonThe Colon

• Colonoscopy

What are the major indications for colonoscopy?What are the major indications for colonoscopy?

• Blood in the stool• Change in bowel habits• Anemia (low blood count)• Personal history of colon cancer or polyps• Family history of colon cancer or polyps• History of colitis• Screening

What is screening?What is screening?

• Preventive Medicine• Evaluation of the asymptomatic patient for disease• Examples of screening:

Pap SmearMammogramProstate rectal exam

Why colonoscopic screening?Why colonoscopic screening?

• Early detection of colon cancer• Removing precancerous polyps• Potential for better survival

State of the art equipmentState of the art equipment

• High definition monitor• 6 colonoscopes• Wide angel viewing 180 degree• Internal stiffener• Variable phase lighting• Anesthetist conscious sedation

How much will it cost?How much will it cost?

• The physician charges $487 for the basic procedure• Medicare will pay $197 to the physician• Facility costs are several thousand dollars

Where can I get a colonoscopy done?Where can I get a colonoscopy done?

• Hospital• Free standing clinic

Hospital or outpatient? Hospital or outpatient?

• Sedated position

Are there other less invasive screening colon tests? Are there other less invasive screening colon tests?

• Stool cards• Sigmoidoscopy• Barium enema• Virtual colonoscopy

What is virtual colonoscopy? What is virtual colonoscopy?

• Evaluation of the colon using a CT scanner• Less invasive• Less expensive?• Non therapeutic• Radiation exposure• Similar preparation

What is the preparation for a colonoscopy? What is the preparation for a colonoscopy?

• A cleansing drink taken over several hours the day prior• Lots of potty training• A half day at the hospital the day of the procedure

What are the complications of this procedure? What are the complications of this procedure?

• Colon perforation• Bleeding• Incomplete colonoscopy (BE)

What are the major colon cancer risk factors? What are the major colon cancer risk factors?

• Age over 50• Family history of polyps or colon cancer• Personal history of colon cancer or polyps• Personal history of colitis

Colonoscopy humor Colonoscopy humor

• Google

Screening colonoscopy in the news Screening colonoscopy in the news

• Flat Polyp• Time of withdrawal• Left verses right colon accuracy• Perforation risk• Fleets prep

Which physicians do colonoscopies? Which physicians do colonoscopies?

• Gastroenterologists• General surgeons• Colorectal surgeons• Others

Physicians available in Clatsop Countyto perform a colonoscopy Physicians available in Clatsop Countyto perform a colonoscopy

• Robert Gustafson, M.D. FACS• William Merry III, M.D., FACS• Truman Sasaki, M.D., FACS• Lee Swanstrom, M.D., FACS• Robert Wayne, M.D., FACS

Normal colon Normal colon

What can be done to decrease the risks ofcolorectal cancer? What can be done to decrease the risks ofcolorectal cancer?

• Increase dietary fiber• Lose weight• Exercise• Low fat diet• Decrease smoking and alcohol

A busy colonoscopy day. A busy colonoscopy day.

Dancing with the stars! Dancing with the stars!