Mentored Professional Enrichment Experience
Applicant :
Chris Simpson
Name of Project/Experience :
"Management of Anticoagulation during Non-Emergent Colonoscopies"
Location where Project/Experience will take place :
Southern Illinois University School of Medicine
Springfield, IL 62794
Mentor Name and Contact Information :
Jan Rakinic, M.D., FACS, FASCRS
Associate Professor of Surgery
Chief, Section of Colorectal Surgery
Program Director, SIU Program in Colorectal Surgery
Vice Chair for Clinical Operations, Dept. of Surgery
Southern Illinois University School of Medicine
P.O. Box 19638
Springfield, IL 62794
(217) 545-7230 jrakinic@siumed.edu
RATIONALE
The American Cancer Society recommends that healthy individuals over the age of fifty should receive a colonoscopy and subsequently every ten years upon a normal examination. There is an even stronger recommendation for colonoscopies to be done on individuals who have a family history of colon cancer, bloody stools, abdominal pain, unexplained bowel habits, and irritable bowel syndrome amongst other indications.
Colonoscopies are one the most reliable ways to screen for colon cancer. A colonoscopy is an endoscopic examination of the entire colon; performed by inserting a flexible tube about four feet long into the anus to visualize the walls of the colon. Upon this examination a gastroenterologist will be able to identify ulcers and/or polyps and allows for a biopsy if malignancy is suspected as well as removal of the polyp. Colonoscopies are generally low risk procedures that generally last less than an hour. The risks involved in this procedure increase significantly when considering patients who are on anticoagulant medications.
Anticoagulants are used commonly in this country to prevent the blood from clotting and are used to treat a variety of ailments such as with patients who have prosthetic heart valves and cardiac arrhythmias. It can also be used to prevent deep vein thrombosis,
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MPEE pulmonary embolisms, myocardial infarctions, strokes, atrial fibrillation, congestive heart failure, and hypercoagulability. One of the common side effects anticoagulant medications, such as the drug Warfarin in relation to a colonoscopy is increased gastrointestinal hemorrhage.
Currently the guidelines to dealing with this decision are obtained from expert opinion; but lack evidenced based research. There is currently a wide variation in the management of patients on anticoagulation medication pre-colonoscopy. Gastroenterologists are faced with the difficult decision of instructing the patient to discontinue the anticoagulation in preparation for the colonoscopy or to continue their medication regiment. The hazards of continuing the anticoagulation medication include increased risk of hemorrhaging during the procedure that might require a blood transfusion or potentially even be fatal. While the complications of discontinuing the anticoagulation medication increase the chances for the patient to have a thromboembolic life-threating event.
The primary objectives of this project are to determine the safest method of managing patients’ anticoagulant medications when a non-emergent colonoscopic evaluation is recommended. The endoscopic and surgical literature contains a number of suggestions for management that are largely empirical.
GOALS
1.
To further my knowledge on the important issue of proper management of anticoagulation as a topic in non-emergent colonoscopies. To gain an understanding on how this issue effects society and the number of people that can be implicated by the difficult choices their physicians have to make to maintain their health.
2.
To determine the safest method of managing patients’ anticoagulant medications when a non-emergent colonoscopic evaluation is recommended with clinical consideration to justify a particular course of action.
3.
To gain an understanding of how and why a retrospective cohort study is designed and carried out.
4.
To personally connect solving a clinical conundrum with evidenced based research.
The majority of the 8-week MPEE project will be devoted to retrospectively reviewing cases of colonoscopies performed on patients requiring anticoagulants and determining the safest method of management. In addition to this I will be shadowing various colorectal surgeons to gain an understanding of the intricacies of their specialty.
METHODS
This will be a retrospective cohort review of patients on chronic anticoagulation and the various associated risk involved with non-emergent colonoscopic evaluations. An IRB proposal will be written and depersonalized medical records will be reviewed to
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MPEE determine the method of anticoagulation management in each case. Whether the method was congruent with the actual colonoscopic findings will also be reviewed and discussed.
ANALYSIS
Determination of the risk congruence of the anticoagulation management method and the colonoscopic findings, we will be able to construct a risk-stratified management algorithm for anticoagulated patients undergoing non-emergent colonoscopies. Data analysis will be accomplished with help from a statistician from the SIU Department of
Surgery.
REFERENCES
"American Cancer Society Guidelines for the Early Detection of Cancer." American
Cancer Society . Leo and Gloria Rosen, 23 June 2011. Web. 20 Jan. 2012.
<http://www.cancer.org/Healthy/FindCancerEarly/CancerScreeningGuidelines/americancancer-society-guidelines-for-the-early-detection-of-cancer>.
Waye, Jerome D., Douglas K. Rex, and Christopher B. Williams. Colonoscopy:
Principles and Practice . Malden, MA: Blackwell, 2003. Print.
SUPPORT
1. Do you request support funds? Yes
2. Would you be able to participate if a scholarship is not available? No
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