Audit on colonoscopy screening in acromegaly patients in a tertiary endocrine unit
Daniel Kannappan, Sami Kenz & Tara Kearney
Aim: To find out all Acromegalic patients above the age of 40 years had their colonoscopic screening or not.
Reason for colonoscopy screening: There is 13 to 14 fold increased risk of colorectal cancer in Acromegaly patients and 2.5 fold increase in mortality from Colonic cancer.
- i) Patientts with acromegaly should be offered regular colonoscopy from the age of 40 years.
- ii) The Frequency of repeat colonoscopy depends on the findings at the original screening and the activity of the underlying acromegaly.
- iii) Patients with adenoma or increased IGF1 needs screening at 3 yearly intervals.
- iv) Negative or hyperplastic polyp in the first colonoscopy needs screening at 5 yearly intervals.
- v) Total colonoscopy is required rather than sigmoidoscopy as 25% of adenomas and 50% of carcinomas occur in ascending and transverse colon.
- i) Total number of Acromegaly patients who had treatment in our centre was 89.
- ii) Out of this 53 patients were under follow up in our hospital and 36 patients were referred back to their original hospital.
- iii) 25 patients (47%) had colonoscopy or virtual colonoscopy and for 5 patients no information was available.
- iv) 18 patients had normal screening, 4 patients had hyperplasic polyp and the remaining 3 patients had adenoma, ulcer and Crohns colitis respectively.
- v) 23 patients did not have colonoscopy. Out of which 8 patients were less than 40 years and screening is not indicated.
- vi) Remaining 15 patients (30%) did not have colonoscopy screening.
Conclusion: The above audit showed nearly one third of our Acromegaly patients did not have colonoscopy screening. This audit has changed our clinical practice and going to be re audited in 12 months.