Comprehensive Guide to Colonoscopy in Singapore

What is Colonoscopy?

• Colonoscopy is a medical procedure where a flexible tube (scope) with a miniaturized camera and lighting system at the tip is skillfully advanced into the anus to the rectum through the large intestine (colon) from the end to the beginning. 
• Colon cancer develops from tiny growths called polyps, and removal will prevent cancer from developing in the future.
• Early detection of small colon cancers is entirely treatable by surgery and has a high chance of cure. Better still, when polyps are removed before transforming into cancer, no surgery is usually required.

Colonoscopy Procedure

• Bowel Preparation is critical to effective colonoscopy. This starts with a low-residue diet 3 days ahead of the procedure. No fiber should be consumed, including fresh fruit and vegetables. The preparation process can be referred to here.
• Before a colonoscopy, a small plastic needle or IV line is inserted into a vein to sedate patients with medications. Once they are asleep, constant monitoring ensures they are anesthetized and unaware. The doctor then inserts the scope into the anus and uses air insufflation and a water jet, applying torque to the scope to maneuver through the colon. A separate channel in the scope allows tissue sampling for analysis and for polyps to be removed using instruments called snares. Small polyps are removed with a “cold” snare like a sharp guillotine that shears the polyp of the colon's lining. Sometimes, clips can be applied to close the resultant defect or to stop residual bleeding. For larger polyps, a “hot” snare is used to apply gentle current energy to the base to fuse small blood vessels and prevent bleeding.
• Colonoscopy preparation is essential as a clean bowel prep will ensure no polyps are missed during the procedure. The scope duration varies depending on the bowel preparation, number of polyps removed, and technical difficulties related to the configuration of the colon, but in general, it takes 30-45 minutes. After the procedure, the patient is moved to a recovery area where all vital parameters like oxygen concentration of the blood, pressure, pulse, and respiratory rate are measured for at least an hour, depending on how quickly the patient recovers. If there are no complications, there should be no pain post-procedure, although there can be gaseous distention from the air insufflated relieved by expelling gas. Important things to look out for are continuous pain or bleeding through the anus, for which your doctor should review the situation.

Colonoscopy Cost in Singapore

• The range of professional fees is stipulated in the MOH Fee Guidelines. Range depends on the case complexity and seniority of the doctor. 
• The variability in costs arises from facility charges (hospitals and day surgery centers), a specialist doctor (anesthetist) providing monitored sedation, and the complexity of polyp removal that can have a bearing on consumables used and tissue analysis (pathology).
• Insurance coverage is essential. Doctors who belong to an insurance panel have an additional requisite fee schedule to adhere to so that costs would be more defined. Additionally, Medisave deductions (according to the procedure schedule) are allowable to offset costs and supplement insurance shortfalls.

Benefits of Colonoscopy for Early Detection

• In Singapore, a person's chance of developing colon and rectal cancer in their lifetime is 5.6%, about 1 in 20. It is currently the number 1 cancer for males and number 2 for females. As alluded to earlier, the development of colon cancer follows a predictable sequence from small polyps to larger, more complex polyps to malignant change. The basis of early detection is the truncation of this process, interrupting any potential for cancer development.
• Many research studies point to the efficacy of colonoscopy in early detection and prevention of cancer. Also, the correlation of the removal of polyps to the reduction in cancer development. This is the basis of guidelines published by professional medical societies advocating the early employment of colonoscopy.

Conclusion

A colonoscopy is an effective screening and preventative tool against the development of colorectal cancer. Current recommendations suggest that average-risk patients can modify their risk by having a first colonoscopy at 50 years of age.

By the time symptoms are present, rectal bleeding, weight loss, anemia, change in bowel habits, or abdominal discomfort and pain, 50% of patients would have presented with advanced disease. Early cancer and polyps may sometimes not present with any symptoms at all.

For patients with a family history of colorectal cancer, it is best to present for colonoscopy 10 years before the age of onset in the affected relative.

Colonoscopy FAQs

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References:

1. https://www.asge.org/docs/default-source/education/practice_guidelines/doc-e49cb8b8-9e3d-4678-9252-0a415efd6c2d.pdf?sfvrsn=fa3a4a51_12
2. https://www.cancer.org/cancer/types/colon-rectal-cancer/causes-risks-prevention/risk-factors.html
3. https://doi.org/10.1056/nejm199312303292701
4. https://nrdo.gov.sg/docs/librariesprovider3/default-document-library/scr-2020-annual-report_web-release.pdf
5. https://www.qxmd.com/r/28555630
6. Screening for colorectal cancer: a targeted, updated systematic review for the U.S. Preventive Services Task Force. Ann Intern Med 2008;149:I-44; PMID:18838719 Epub 2008 Oct 6 WhitlockEP, LinJS, LilesE, et al.
7. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/colorectal-cancer-screening