Low-cost, office-based, screening colonoscopy

Performing full colonoscopy at regular intervals and removing lesions at an early stage might significantly lower the incidence and mortality of colorectal cancer. Such a program must be inexpensive, safe, and time-efficient.

Screening colonoscopy was performed on 639 patients. For a normal examination, the physician's time is limited to giving the medication for conscious sedation, performing the colonoscopy, and completing a written report form. The total charge for a normal screening colonoscopy is $150.

Adenomatous and/or hyperplastic polyps were detected in 218 patients (34.1%). One hundred sixty adenomatous and 134 hyperplastic polyps were removed. Forty-eight percent (48.1%) of the adenomatous and 21.6% of the hyperplastic polyps were above the sigmoid colon. Six adenocarcinomas were detected in five patients. One patient had a delayed bleeding episode requiring no transfusion or therapeutic intervention, and one patient had a "post-polypectomy syndrome" requiring no therapeutic intervention. The average physician time in the endoscopy room for normal examinations was 18 min.

Screening colonoscopy can be safely performed in an office facility. Physician time with the patient should be limited to allow a low cost that compares favorably with screening costs for other malignancies. Long-term studies to assess the capability of screening colonoscopy to lower mortality from colorectal cancer should continue.