I've had UC since 2012 and I've had one (1) colonoscopy which initially diagnosed me. I've had more flexible-sigmoidoscopies than I can count, as I always prefer those whenever it comes up.
My NH gasteroenteroligist (pretty traditional in mindset) was pretty scope-happy. I dreaded telling him I was flaring or a treatment wasn't working as that line of talk pretty much guaranteed a "well let's schedule endoscopy and take a look!". I probably had, on average two flex-sigmoidoscopies a year while a patient there. Sure they're a pain in the arse, but at least they're a quick procedure and you know right away how you're doing.
My VT gasteroenteroligist (at the teaching-hospital), I've been seeing since April 2017 and I haven't had a scope yet. I asked him and he says endoscopy is accurate but it also disturbs the gut flora and is something he's more cautious to use. He said for Colorectal Cancer screenings that's another thing and as I'm approaching the 8-10 year mark with UC then they're going to be necessary. Now, we talk about
current UC symptoms, any changes since last-time, and do my current UC symptoms at all impact my quality of life. He ran a FCP and CRP over the summer when I saw blood and urgency reoccur during a blip or small flare.
Overall endoscopy is the most accurate tool gasteroenterolgists have, it enables you to see what the inflammation looks like, how far it extends, how severe it is, and take biopsies to confirm what was seen. For that reason it is the gold-standard for initial diagnosis and colorectal cancer screening. It's like having 20/20 vision, you have the best clarity. Can you tell enough to make an informed decision without endoscopy (that is with a bit less accurate data)? I think in some cases yes and in other cases no.
How are you doing? Is a pretty relative thing when asked in a typical gasteroenterolgist office consultation. If I'm doing good compared to how I was doing when I was flaring, then I am feeling great relatively. However is that doing good mean I am in a remission or that I still have ongoing UC symptoms that are impacting my quality of life? My definition of great and your definition of great might mean two entirely different things, depending on the trend of how we've been doing lately (our trend).
My general thoughts:
At the onset of a moderate or severe flare, I think it's a good idea to get at least a flex-sigmoidoscopy to assess how severe and how far in extent as it enables you to most accurately match an appropriate-strength treatment to combat your flare.
At the onset of a mild flare, I'd wager a FCP stool test or CRP blood test would tell you enough. You can hit it mildly and see if you get a response. Same goes for simmering inflammation that hasn't really changed over time, you know you have inflammation. What's a scope going to tell you other than the obvious?
To monitor if our inflammation-levels have changed over time, I am sure FCP or CRP is sufficient once or twice a year to see where you/I stand.
There's times your gasteroenterolgist might need to do a flex-sig to prove an expensive treatment is working, like after going on a biologic. As I'm sure health insurance asks for proof to go from loading doses to maintenance doses in some cases. Endoscopic changes before and after biologic use are as rock solid as you can get.
Moderator Ulcerative Colitis
John, 39, UC Proctosigmoiditis
Rx: Remicade @5mgs/kg/6wks; daily 75mgs 6MP, 4.8g generic-Lialda, and rowasaA semi-finalist in the Olympic 15-meter bathroom-sprint. Aimed for the gold but just ended up getting brown...
Post Edited (iPoop) : 1/25/2018 8:13:15 AM (GMT-7)