Colonoscopy is a medical test used to investigate bowel disease. A flexible tube with a light source is passed up through the large bowel and the specialist is able to visualise the inside of the colon. If he sees an area with possible disease he also has the facility to take a biopsy, which can then be analysed by a pathologist in order to confirm a diagnosis.
Colonoscopy is usually performed as a day case, with sedation rather than a general anaesthetic. For the test to be successful, the patient must "clear out" the bowel in the days preceding the appointment by drinking a special preparation that ensures the colon is clearly visualised by the specialist.
Colonoscopy is the investigation of choice for a patient with unexplained bleeding from the back passage. In this situation, the test should be performed in a matter of weeks. It is also used to check for bowel cancer and inflammatory bowel diseases such as Crohn's disease and ulcerative colitis. The test has a high level of diagnostic accuracy.
The Republic: John is a 67year-old retired labourer from Co Waterford. He has a medical card and does not have the facility to access private medical care. He presented to his GP in May 1998 with fresh bleeding from his back passage. When he was referred to the local hospital, he was told the earliest appointment for a colonoscopy would be in two months' time.
Concerned about the real possibility of colon cancer, John's GP telephoned a friend who was a surgeon in another hospital. He agreed to perform a colonoscopy on John within two weeks. He was eventually diagnosed with ulcerative colitis - a condition in which the colon becomes red, inflamed and ulcerated - and he responded to treatment with medication. He remains well despite occasional flare-ups of the inflammatory bowel problem.
Northern Ireland: Francis is a 22-year-old council official from Co Antrim. He presented to his GP on October 20th, 2000, complaining of loose bowel motions and crampy abdominal pain but with no weight loss or bleeding.
The family doctor referred him for a routine gastroenterology appointment at the regional hospital, where he was seen on December 13th. Francis eventually had a colonoscopy, on February 2nd, which was normal. He was, however, diagnosed with irritable bowel syndrome, a troublesome but benign condition.
According to both GPs, if a patient needs an urgent colonoscopy because of rectal bleeding, the only way the GP can obtain one is to ring a consultant whom he knows well.
Comparison: Neither health service has a system in place to deal adequately with the need for urgent bowel investigations. Both GPs told The Irish Times it is not good enough that personal friendships are needed to ensure proper, safe patient care. It is worrying that both doctors felt they had to use personal rather than professional relationships to ensure a quick diagnosis in a patient with rectal bleeding.
The routine waiting time of two to three months in both systems for gastroenterology outpatients is acceptable. However, both health services need to develop rapid colonoscopy clinics, similar to those already in place for chest pain and breast lumps, to deal with urgent cases. It is not good enough that the system relies on ad-hoc goodwill to deal with symptoms which could represent bowel cancer, a condition for which the overall survival statistics remain poor.