What is Open-Access Colonoscopy

What is Open-Access Colonoscopy? Open-Access Colonoscopy is performed without prior consultation with a gastrointestinal specialist. OAC may be appropriate for healthy patients who need a screening colonoscopy and who would like to avoid the extra time and expense of a consultation (please page down to learn more about colorectal cancer screening). Your procedure will be performed by William Karnes, MD.

Please note that while most insurance companies cover screening colonoscopy, some do not. If you are unsure, please contact your insurance company.

Open-Access Colonoscopy does not substitute for consultation. If you have symptoms, please call 805-563-0024 to schedule a pre-colonoscopy visit with Dr. Karnes.

If you are eligible for and desire to have an Open-Access Colonoscopy, please complete our intelligent online registration form. Upon receipt and review of the forms, Dr. Karnes will contact you and help you schedule your procedure.

How do I know if I am Eligible for Open Access Colonoscopy?

You may be eligible for OAC if you can answer "YES" to ALL of the following questions

1) Are you "average risk*" for colorectal cancer between age 50 and 80? -OR- Are you "high risk*" for colorectal cancer and between age 40 and 80?

* "Average risk" means: you have no first degree relatives with colorectal cancer or polyps, and you have no personal history of polyps, colorectal cancer or inflammatory bowel disease of the colon.

* "High risk" means: you have one or more first degree relative(s) with colorectal cancer or polyps (under age 70 at diagnosis), and/or you have a personal history of polyps, and/or a personal history of inflammatory bowel disease of the colon.

** Consultation is highly recommended for people with "Very High Risk" for colorectal cancer due to family history of colorectal cancer affecting multiple family members, especially if any cancers are diagnosed under age 50. For these people, consultation is required to determine the proper timing and intervals of colonoscopy.

2) If you are "average risk", was your last colonoscopy 10 years ago or more, or was your flexible sigmoidoscopy 5 years ago or more? You may answer YES if you have never had a colon exam.

3) If you are "high risk", was your last colonoscopy 5 years ago or more? You may answer YES if you have never had a colon exam.

4) Do you consider yourself healthy?

Please schedule a consultation instead of OAC if you answer "YES" to any of the following questions about your current health status:

1) Are you pregnant?

2) Have you had previous problems with anesthesia or conscious sedation?

3) Are you actively taking anticoagulant/antiplatelet drugs (coumadin, plavix, aggrenox, etc.)? Aspirin (even 81 mg) and gingko biloba should be stopped one week prior to the procedure to reduce the risk of bleeding.

4) Do you have any conditions affecting your heart, lungs, liver, or kidneys that requires active medical treatment (other than mild high blood pressure or elevated cholesterol)?

5) Do you take insulin or have diabetes that is difficult to control?

6) Do you have a psychiatric condition that is difficult to control?

7) Do you currently abuse alcohol or drugs?

8) Do you have active gastrointestinal symptoms? A formal consultation is recommended for patients with symptoms, although colonoscopy may eventually be part of the evaluation.

How do I schedule an OAC?

Complete our intelligent online registration form.

Upon receipt and review of the forms, Dr. Karnes will contact you and help you schedule your procedure.

After you appointment is made, you will be provided specific instructions to prepare for your colonoscopy.

What if I have more questions about Open Access Colonoscopy?

I want to learn more about colorectal cancer screening:

Topic Links

Why should I consider a colon cancer screening test?
Why should I choose colonoscopy for screening?
Aren’t there down sides of colonoscopy?
Do I have other choices for colon cancer screening?
What if I have a higher-than-average risk for colon cancer?
How can I tell if I have polyps?
When should I start screening?
Will my insurance cover this?
Don't wait until it's too late...

Why should I consider a colon cancer screening test?

Over 50,000 people will die from colon cancer this year in the United States, making this cancer the leading cause of cancer death among nonsmokers. Smokers are not protected from colon cancer. They are just more likely to get lung cancer.

The average American has a 1 in 18 chance of getting colon cancer. Everyone is at risk, independently of your race or gender. Your risk is higher if you have a family history of colorectal cancer, or if you have a personal history of precancerous polyps, colon cancer or inflammatory bowel disease of the colon (Ulcerative Colitis or Crohns colitis).

The good news is that colon cancer is preventable. The majority of colon cancers begin as polyps (they look like small warts in the colon). Polyps are benign growths that may reside in the colon for 10 years or more before they become cancer. This 10-year period is our “window of opportunity” when polyp(s) can be removed before they have a chance to become cancer.

The likelihood that you have a polyp right now depends on your age. 50-year-olds have a 1 in 5 chance of having one or more polyps. 60-year-olds have a 1 in 3 chance. By age 70, the risk increases to nearly 50%! Although most polyps do not become cancer, perhaps 1 in 5 will become cancer if left in the colon long enough. Unfortunately, even the polyps that are destined to become cancer rarely cause any symptoms.

Periodic screening of your colon and removal of polyps reduces your risk of getting colon cancer. Screening methods differ in their ability to detect and remove polyps, and in their effectiveness to reduce your risk of getting colon cancer. But any screening is better than no screening!!

Why should I choose colonoscopy for screening?

Colonoscopy is the “gold-standard” method for screening your colon for polyps and cancer. There is no better test for finding polyps, because colonoscopy examines the entire colon. Also, colonoscopy is the only test that allows us to remove all polyps from your colon. When performed at the appropriate intervals, colonoscopy may reduce your risk of colon cancer by up to 90%. In other words, if you have an average risk for colon cancer, your risk can be reduced from 1 in 18 to as low as 1 in 180!

Aren’t there down sides of colonoscopy?

Yes. colonoscopy is usually done with mild sedation (twilight sleep) and takes about 30 minutes. Most patients are pleasantly surprised by how simple and painless the procedure is. The biggest complaint is the laxative preparation the night before, which may sometimes cause nausea, vomiting, bloating and abdominal cramps in addition to the expected diarrhea and urgency to reach a bathroom. When you arrive for the procedure, you will need an IV catheter placed in your arm or hand. If you and your doctor choose to use sedation during the procedure, you will be required to wait in the recovery room for up to an hour after the test, and you will not be allowed to drive, use dangerous machinery, or be responsible for others for the remainder of the day. You will lose a day of work (or play) and you will need to impose on someone to drive you home and be with you after the procedure. If you do not require sedation, you may avoid these restrictions after the procedure. The risk of serious complications of colonoscopy is about 1 in 1500.

Do I have other choices for colon cancer screening?

If you have an average risk for colon cancer then you have other choices besides colonoscopy for colon screening. These other choices are not as effective as colonoscopy for reducing your risk of getting colon cancer. However, they have some advantages that may be important to you. For example, an annual stool Hemoccult test is a safe, painless, inexpensive and easy test that involves placing a smear of three separate stools on 3 cards. The Hemoccult stool test can miss up to 85% of colon polyps and 60% of colon cancers. For this reason, it is often combined with a flexible sigmoidoscopy "short scope" test.

Compared to colonoscopy, flexible sigmoidoscopy is easier to prepare for, takes less time, does not require sedation so you can drive yourself home and even go back to work, and the risks of serious complications are lower than colonoscopy (1 in 10,000 vs. 1 in 1500). A flexible sigmoidoscopy is limited because it examines only the lower third of the colon. Sigmoidoscopy is also recommended to be performed every 5 years, which is more often than screening colonoscopy, and flexible sigmoidoscopy cannot be used to clear your colon of polyps. If polyps are found, a colonoscopy will be required to remove them. When combined with yearly Hemoccults, flexible sigmoidoscopy reduces the risk of dying from colon cancer by 30-50%, which is about half as effective as colonoscopy.

Another option is a barium enema x-ray of the colon, but again the accuracy is limited. Less than half of significant colon polyps are detected. Furthermore, the preparation is similar to colonoscopy and the test can be uncomfortable because of air and barium insufflation of the colon without sedation.

Virtual colonoscopy is a newer test that is not yet widely available. It uses a CT scan to examine the colon. The test can detect polyps throughout the colon with an accuracy that is nearly as good as colonoscopy. However, like the barium enema, the preparation is the same or similar to that used for colonoscopy and the test is often uncomfortable because of air insufflation of the colon without sedation.

Keep in mind in as you choose your screening test, that if a polyp is found by flexible sigmoidoscopy, barium enema, or virtual colonoscopy, or if your Hemoccult test is positive, colonoscopy will be required to find and remove the polyps. In other words, colonoscopy is the final common pathway to colon cancer prevention because it is the only test that can remove all polyps.

But any screening is better than no screening! Don't wait until its too late!

What if I have a higher-than-average risk for colon cancer?

As a colon cancer screening test, colonoscopy is considered the “standard of care” for people with family history colon cancer, prior history of precancerous polyps or colon cancer, prior history of breast or uterine cancer, or long-standing inflammatory bowel disease, such as ulcerative colitis and Crohns colitis. Typically, if you fit into one of these higher risk categories, you should start colonoscopies at a younger age and have them at more frequent intervals. The timing is often determined on a case-by-case basis.

How can I tell if I have polyps?

You can't. Colon polyps usually don’t cause symptoms. In most cases, by the time symptoms develop, such as rectal bleeding or change in bowel habit, the polyp has already become an incurable cancer that has spread to the liver and other organs. Over 60% of people who wait for symptoms are incurable at the time of diagnosis.

When should I start screening?

Current guidelines recommend that we undergo colon cancer screening after we reach a certain age. A colonoscopy is an excellent way to screen for colon cancer and is frequently recommended for all average-risk adults over the age of 50. If the exam is normal and there are no other risk factors, a re-exam at 10 year intervals is recommended. Medicare recipients over age 50 are eligible for a screening colonoscopy every ten years if they have not had a colonoscopy within the past 10 years or a flexible sigmoidoscopy within the past 4 years. If you have worrisome symptoms, colonoscopy can be done sooner for diagnostic purposes.

If you have a first degree family member with colon cancer diagnosed under age 60, you should start colonoscopy screening at age 40, or ten years younger than the age of diagnosis of the cancer, whichever is younger. You should also get colonoscopy every 5 years thereafter. Some family histories warrant an even more aggressive approach. If you have a history of precancerous polyps, ulcerative or Crohns colitis, or prior history of cancer of the colon or rectum you will need more frequent colonoscopy screening. The timing and intervals should be discussed with your gastroenterologist.

Will my insurance cover this?

It depends upon the insurance plan. Medicare recipients over age 50 are now covered if they have not had a previous colonoscopy within the past ten years or a flexible sigmoidoscopy within the past 4 years. Many corporations now offer this benefit to their executives. Those with private or HMO insurance should contact their benefits representative for more information. Pending Congressional legislation may mandate coverage by all insurers in the near future. Some individuals who lack insurance coverage for this procedure elect to assume the costs personally for peace of mind sake.

Don't wait until it's too late...

One in 18 Americans now develops colon or rectal cancer in their lifetime and the majority of these are diagnosed at an advanced incurable stage. This is sad and unnecessary because the precursors to colon cancer, polyps, usually give us a 10-year "grace period" before they develop into cancer. Polyps are easy to find and easy to remove. Unfortunately, most individuals do not take advantage of this opportunity to prevent colon cancer because they were either misinformed, embarrassed, too busy, or just afraid to call and schedule a screening exam. Don't be one of those individuals who regrets not getting screened 5-10 years earlier when your newly diagnosed colorectal cancer was still a benign polyp. The only good polyps are those in a jar!