We hope that this latest Banding Bulletin finds you well! We all know that March is Colon Cancer Awareness Month, which is sure to bring in a number of patients that want to be screened, at least in part due to their finding of blood in their stool or on their toilet paper. With that in mind, we’ll follow with some “tips and tricks” when it comes to working with these patients.
The CRH Patient Questionnaire:
Our physician-centric website (found HERE) has all sorts of resources designed to help you to efficiently and effectively evaluate and treat your patients with anorectal issues. One of the forms (available in several languages) will help you to document the patients’ anorectal symptoms and other medical issues, as well as help you to identify potential candidates for the various procedures that we espouse.
Very often, patients (particularly “direct access” colonoscopy patients) are scoped, and found to have significant hemorrhoidal disease. The patients are scheduled for a follow-up in the office to be banded, and on exam, are found to be tender on DRE, precluding the patient from being treated at that time. As we know, this tenderness is overwhelmingly due to a coexistent anal fissure. Well, that patient had that same fissure a couple of weeks ago on the endo table, but the fissure wasn’t evident to the examiner because the patient was sedated at the time of their exam!
So, the simplest thing you can do, is hold off on the sedation for 30 seconds – enough time for a satisfactory DRE – prior to beginning the endoscopic procedure. Remember that, practically speaking, tenderness at the anal introitus is caused overwhelmingly by one or more of 4 issues . . .thrombosed external hemorrhoids, perianal abscess, fistula in ano, or an ANAL FISSURE!! If we start treating that fissure immediately, by the time that they come in to get their coexistent hemorrhoids treated, they are already feeling better, and will tolerate their evaluation and treatment that much better!
The colonoscope is fantastic for a colorectal examination . . . but not so much when it comes to the anorectum!
A great study was performed some years ago, comparing the accuracy of diagnosing anorectal issues with the use of the anoscope, the flexible scope on straight withdrawal, and the flexible scope in retroflexion. The anoscope picked up on 99% of the anorectal issues, while the flexible scope in retroflexion missed more than 40% of the issues. So, while the scope is awesome for everything else, the proper way to best evaluate the anorectum is with an examining finger on an awake patient, and with an anoscope!
If you are not currently using anoscopy to better evaluate your patients, let us know and we’ll get you what you need in order to better provide these services!
CRH Anesthesia continues to grow!
CRH Anesthesia is now serving 59 ASCs in twelve states, performing over 370,000 procedures per year AND we’ve grown our anesthesia team to better serve our customers! We are looking to continue that expansion, so if you currently: own your anesthesia program and would like to increase its financial success as well as to realize some of the equity that has been built up in the practice, outsource your anesthesia and would like to bring it “in house”, or if you are interested in transitioning from conscious sedation to deep sedation, we’d love to speak with you.
If you fall into any of these groups, please contact ME, and we’ll start a discussion to see how we can best meet your needs.
CRH is coming to a conference near you!
We’re hitting the road this spring and hope to see you at one of the upcoming meetings:
ACG/FGS Annual Spring Symposium
Digestive Disease Week
Thanks again for having a look at this edition of the Banding Bulletin! Please contact ME if you have any partners, peers, or Advanced Practitioners that are interested in being trained or in having a “refresher session”. Keep an eye out for a webinar announcement as well – we’re planning on having 4 sessions on Thursday, March 26th.
Have a great day and we look forward to working with you sometime soon.