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Chris Macklin
Colorectal Surgeon

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Colorectal Website Review: Colonoscopy

This section provides a monthly review of websites both from the specialist colorectal surgeon, colorectal nurse specialist and the patient’s perspectives.

A different topic will be addressed every issue. If you have any topic or website suggestions then please send them to: website.review@colorectalsurgeon.org.uk

Colonoscopy

Colonoscopy of the entire colon, and endoscopic excision of polyps, began in June and September of 1969, respectively. Colonoscopy is regarded as the gold standard investigation for colorectal symptoms and is established in its role in colorectal cancer screening for family history. But what has the internet got to offer for the colorectal surgeon or physician, nurse specialist and patient?

For the physician and specialist nurse:

Colorectal Cancer Screening and Surveillance Guidelines
	The National Guideline Clearinghouse is a comprehensive database of evidence-based clinical practice guidelines. This review details current American recommendations for stratifying at risk individuals, the options for screening those in different at risk groups and guidelines for surveillance following adenoma, cancer or IBD.
	This review is comprehensive, produced by a distinguished authorship and was published in Gastroenterology in 2003.

Colonoscopy Training
	Training in colonoscopy has until recently been an unstructured apprenticeship. The Joint Advisory Group on Gastrointestinal Endoscopy in the U.K. was established to try and address significant training issues to ensure quality. Its guidelines for the training, appraisal and assessment of trainees in GI Endoscopy is currently in its third revision published in 2004.
	Most pertinent to the U.K. but the guidelines provide good recommendations that could be adopted in any country.

	Similarly, in the U.S. the American Society for Gastrointestinal Endoscopy have an excellent website that covers all aspects of endoscopy training and competence.
	This is an excellent site that is over-brimming with information. It make take a little searching to find the precise information but it is worth it.

	This website from the Royal College of Surgeons of Edinburgh gives a basic overview of colonoscopy for surgical trainees, nurses or non-medical endoscopists from the indications and equipment to the techniques involved.
	There are relatively few sites that aim to help someone embarking on colonoscopy training and this one delivers the basics.

Processing Endoscopes
	The American Society for Gastrointestinal Endoscopy have produced detailed guidelines for the reprocessing of flexible endoscopes.
	This is the first website I have seen that deals with the mundane but important topic of scope disinfection and therefore is quite unique. It would be a useful reference source for any department reviewing its disinfection policy.

Colonoscopy Atlases
	There are many good sites that provide images taken at colonoscopy as a source of education and reference.One of the best video sites is The DAVE Project, an acronym for the Digital Atlas of Video Education, from Harvard Medical School. The project consists of a gastrointestinal endoscopy video atlas and medical lectures and presentations.
	This is an excellent multimedia site with clear informative video presentations (requiring the Realplayer plugin).

	Atlanta South Gastroenterology have produced a comprehensive selection of images in 82 sections that cover most pathological processes commonly encountered at colonoscopy.
	The strength of this atlas is that it provides a quick visual review of a pathological topic to aid revision or as a self-test.

	The Feldman’s Atlas and Jaramillo Atlas are accessible from gastrosource.com following free registration and provide many high quality images that are downloadable as PowerPoint slides for use in presentations.
	This site requires you to login but does accept cookies so that it will remember you from your office or home computer. It is an excellent resource if you are hunting for that perfect picture for a presentation.

For the patient:
	There has been a rapid expansion in websites that provide information for patients and there are many sites concerning colonoscopy. The Best Treatments website is produced by the British Medical Journal and provides detailed information on having a colonoscopy, the complications and the alternatives.
	A very simple website with clear diagrams and straight forward explanation that answers the commonest patient questions about colonoscopy

	The National Digestive Diseases Information Clearinghouse is a producer of quality publications that are free from copyright.
	A similarly clear and concise website of patient information

	This website created by The Society of American Gastrointestinal and Endoscopic Surgeons is dedicated to colonoscopy with presentations for patients
	By virtue of its name, this is likely to be one of the first sites a patient might visit. The website is too bold and needs updating but the content is appropriate.

	The Cancer Research and Prevention Foundation is a non-profit organisation whose mission is the prevention and early detection of cancer. Their website has videos of interviews of patient’s experiences and answers to many pertinent questions for patients.
	The ability to gain insight from sharing other peoples experience even through an online interview is not to be underestimated. I am sure that this site will help to reassure the over-anxious beforea colonoscopy.

	The U.S. National Library of Medicine and the National Institutes of Health have created an excellent multimedia presentation for patients undergoing colonoscopy.
	This audiovisual interactive presentation is excellent at giving a stepwise detailed view of the patient pathway and is to be recommended.

Next month: Intestinal Stomas