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photo showing a composition of medical items including blue pills, injections, and a syringe | GI NorthHemorrhoids or piles are swollen veins in the lower part of the anus and rectum. A more severe case is when the blood vessel walls are stretched so thin that the veins become irritated and bulge especially when relieving the bowels.

Rendering to Medical News Today, a hemorrhoid can be very painful and dreadful but are preventable and effortlessly treated. Left untreated, a hemorrhoid will actually worsen over time. In fact, most physicians recommend seeking immediate care.

Medical News Today also reports there are up to 75 percent of adults in the US and Europe will have a hemorrhoid at some time in their lives. And about 50 percent of the same people are over 50 years old. Most will also need treatment. However, only about 4 percent seek medical treatment.

For the most part, a hemorrhoid is most common in adults between the ages of 45 to 65. However, young adults and children can also get a hemorrhoid. As well, they are more common in men than in woman. Moreover, pregnant woman are very likely to get hemorrhoids.


There are a wide variety of factors that can cause a hemorrhoid such as prolonged sitting or standing, hard stools (generally a lack of fiber), great strain during a bowel movement and heredity.

During pregnancy, there is a lot of excess weight and pressure on the rectum. This puts strain on the veins resulting in irritation and swelling. Also, during childbirth the veins go through a lot of strain and pressure that often causes a hemorrhoid.

Numerous Types

Basically, there are two types of hemorrhoids. If the hemorrhoid first arises from the lower part of the anal canal close to the anus, it is regarded as an external hemorrhoid. If it is inside the rectum, it is known as an internal hemorrhoid.

An external hemorrhoid is the most recognized. They also cause a lot of pain due to clotting under the skin and irritation. Internal hemorrhoids are difficult to diagnose because they are not within sight and are generally painless. However, according to the Mayo Clinic, an internal hemorrhoid may not be painful but they do tend to bleed

Hemorrhoid Symptoms

The most common hemorrhoid symptoms are pain near the rectal area, bleeding during bowel movements and itching. Sometimes that can also be blood in the stool or toilet paper. In the medical world, physicians often use a grading scale that describes the level of hemorrhoids:

1st degree – A hemorrhoid that is bleeding but is not prolapsed.
2nd degree – Hemorrhoids that are prolapsed and retracted (may or may not be bleeding).
3rd degree – The hemorrhoid has prolapsed and needs to be pushed back in.
4th degree – The hemorrhoids have prolapsed and cannot be pushed back in.


One of the best ways to prevent hemorrhoids is a healthy diet and lifestyle such as:
• Daily exercise to improve blood circulation
• Eat a diet high in fiber and plenty of water to encourage soft stools.
• Avoid extended amount of hours of sitting or standing. If work requires you to sit all day, use a doughnut pillow and move around every 20 minutes.


Sometimes severe cases require surgery, but it is not a common necessity. If you suspect that your hemorrhoids are severe, do not hesitate to contact your doctor or a physician at GI North that specializes in gastroenterology and other issues such as hemorrhoids. Dr. Cofrancesco and Dr. Quijano at GI North serve the Cumming, GA area as well as Alpharetta, Canton, Roswell and Suwanee. Dr. Quijano also speaks fluent Spanish.

© 2016 GI North Gastroenterology Services. All rights reserved.

photo of Thanksgiving Turkey dinner | GI NorthThe holidays are upon us and that means getting together with family for large meals around the dining room table. Unfortunately, many of us end up with stomach upsets or indigestion after eating much more than we’re used to having at one sitting.


Your digestive system is composed of the gastrointestinal (GI) tract, liver, pancreas and gallbladder. When you eat food, it travels through the hollow “tubes” that make up the GI tract, making its way through other organs that take in nutrients, with the waste passing through the anus.

Digesting food is vital for getting nutrients into your system. The digestive process involves chewing food, swallowing it into the esophagus, stomach, small intestine, pancreas and liver. Your body uses muscles and natural digestive juices to move the food and nutrients along.

How Holiday Meals Can Cause Stomach Upsets

When you eat large portions of food in one sitting, it puts pressure on your esophageal sphincter. When that pressure builds, it can cause food and acid to move back up, causing heartburn. In fact, your entire digestive system can be slowed down, causing stomachache and constipation.

Those rich foods on the table are mostly full of sugar and fat. Fat can slow digestion and cause reflux. The same is true of chocolates, coffee, and acidic foods.

The stress of the holidays can also be the cause of stomach upsets. Think of all that shopping for gifts, cooking, cleaning, traveling, and arguing with family members. Stress can result in upset stomachs and heartburn, plus, when you are stressed, you may want to deal with the tension by drinking and eating too much.

Preventing Stomach Upsets

Before going to or hosting a large holiday dinner, try to plan your behavior ahead of time and become aware of how much you’re eating. Here are a few tips to avoid stomach upsets:

  • Only have a second helping of that one dish you really enjoy.
  • When you know the holiday dinner will be especially rich and fatty, compensate by eating a healthy lunch of high-fiber foods.
  • Be conscious of everything you eat throughout the holiday season. Think before you eat, because tasty treats will be everywhere!
  • Eat lavish meals slowly. Savor your food and you won’t overeat as much.
  • Alcohol can irritate your GI tract, so don’t overdo it.
  • Take a short walk after a large meal instead of collapsing on a couch for a nap.

When To Seek Help for Digestive Issues

If you experience ongoing, longer-lasting symptoms that go beyond the holidays and occasional stomach upsets, diarrhea or a little heartburn, then it may be time to see a GI specialist.

The staff and physicians at GI North specialize in digestive system medicine. Dr. Simon Cofrancesco, a gastroenterologist, founded GI North in 2011. Dr. Sergio Quijano, who speaks fluent Spanish, joined the GI North practice after moving to Georgia from New York. GI North serves the Cumming, GA area, including Alpharetta, Roswell, Canton, Suwanee and beyond.

The above article is not meant to take the place of professional medical advice. Please call the staff at GI North if you have any questions or wish to make an appointment.

© 2016 GI North Gastroenterology Services. All rights reserved.

medical illustration showing colon polyps | GI NorthColonoscopy has become an integral part of routine preventive care. While health promotion materials regarding regular colonoscopy screening has become wide-spread, what often remains unclear for patients is just why this exam is so important. By further discussing the need for colonoscopies, it may become apparent how the Adenoma Detection Rate (ADR) further indicates the need for routine colonoscopies.

What you need to know about adenomas

Adenomas, abnormal growths that can be found in many parts of the body, are benign by definition. This means that they are localized accumulations of abnormal cells. Adenomas are also referred to as polyps, or adenomatous polyps. After the age of 50, nearly 2 in 5 people can expect to have these abnormal growths in the colon but only about 2% of these adenomas ever pose the risk of transformation to colon cancer.

Detection of adenomas is important because they have the potential to become malignant (i.e. cancerous). In fact, around 1 in 20 apparently adenomatous polyps in the colon actually harbor cancerous cells. The size of an ademoma can be an important indicator as to the risk of cancerous transformation: polyps over 2 cm in size (or about ¾”) have up to a 40% chance of being malignant, while the risk can be as low as 1% with small polyps.

Why you need to have adenomas removed

During routine colonoscopies, adenomas are regularly removed, a process called polypectomy. This is done in order to examine the tissue microscopically and determine if it contains any cancerous cells. Having removed a growth that was later found to be cancerous, the process of polypectomy is not only diagnostic, it can also be curative. In such cases, a physician may recommend more frequent colonoscopies to ensure that the curative process was complete.

What the adenoma detection rate can indicate

The adenoma detection rate (ADR) is the percentage of patients over 50 years old who are undergoing a colonoscopy screening test for the first time and who have one or more adenomas found and removed during the procedure.

Higher ADRs have been linked to lower rates of cancer in patients who have undergone colonoscopy. The ADR can be influenced both by the prevalence of adenomas in the population at-large as well as by the technique of the gastroenterologist performing the colonoscopy. Look for a colonoscopist who can report a high ADR, as this is suggestive of a high quality of care.

How to decrease your risk of colon cancer

While this article is intended to be informative, it is no substitute for professional medical advice. Visit a health care provider to learn more about your risk of colon cancer and how colonoscopy should be incorporated into your health maintenance plan.

Turn to GI North for all your colonoscopy and gastrointestinal health needs. Drs. Cofrancesco and Quijano and their GI North team serve the Cumming, GA area as well as the surrounding areas of Alpharetta, Roswell, Canton, and Suwanee. GI North welcomes patients who prefer health care services in Spanish, as Dr. Quijano is fluent. Whether for an ounce of prevention or a pound of cure, find out today how GI North can address your GI health concerns.

© 2016 GI North Gastroenterology Services. All rights reserved.

photo of oatmeal and raspberries in a white bowl | high fiber dietBetween the inconvenience of digestive discomfort and the risk for serious diseases of the digestive tract, there are more than enough reasons to seek-out the best foods for digestive health.

Eat your roughage: why Grandma was right

Adequate intake of dietary fiber has long been recognized as fundamental to good digestive health. As it turns out, eating your vegetables really can help to fend off serious diseases such as colon cancer. Despite long-standing advice to have a diet rich in fiber, Americans currently only get about half of the recommended 25-30 grams of dietary fiber daily.

Enhance your fiber intake with a variety of fiber-rich foods such as split peas (16 grams), artichoke (10 grams), raspberries (8 grams) and instant oatmeal (4 grams). Save the prepared fiber nutritional supplements for moments when a bit of extra fiber is required, such as during an occasional bought of constipation. Consider consulting a medical professional for cases of frequent constipation.

The gut microbiome: your bacterial buddies

Although the idea may take some getting used to, bacteria are one of the most important contributors to digestive health. The specific composition of commensal flora contained in the digestive tract determine how well we can fend off pathogenic organisms. These bacteria can also help break down the foods we eat and provide important proteins that affect how well we absorb the nutrients in our food. This may be why studies on obesity have found compelling connections between the types of microbes in the gut and the risk for obesity.

Maintaining a healthy microbiome

In order to keep the gut microbiome in tip-top shape, be sure to get regular servings of probiotic and prebiotic foods. Due to their generous content of gut-friendly bacteria, probiotic foods help ensure that the ratio of friend-to-foe in the digestive tract stays tipped in your favor. Probiotic foods include natural yogurts and other types of fermented foods including kefir, miso, kombucha and sauerkraut.

Help keep the friendly bacteria thriving by also getting generous doses of prebiotic foods, those on which the friendly gut flora flourish. Inulin, a special type of starch, is a prebiotic that can be found as a supplement in many foods such as yogurts and yogurt drinks and can also be found occurring naturally in chicory. Other foods containing naturally-occurring prebiotics include bananas, oatmeal, asparagus, garlic, onions and leeks.

Finding your digestive health coach

While this article is intended to be informative, it is not a substitute for professional medical advice.

Consider a visit to GI North to address all your digestive health needs. From optimizing dietary plans for digestive health to treating advanced disease, GI North provides a full-range of services for the GI tract. Along with their GI North team, Drs. Cofrancesco and Quijano serve the Cumming, GA area as well as the surrounding areas of Alpharetta, Roswell, Canton, and Suwanee. Appointments are also available in Spanish: Dr. Quijano speaks fluently.

© 2016 GI North Gastroenterology Services. All rights reserved.

help with digestive issues | GI North | north Atlanta area

Stress and Digestion: The Brain-Gut Link

Anyone who has ever felt butterflies in their stomach or felt their stomach was tied in knots, knows that stress affects digestion. Many people can’t eat when stressed while others tend to overeat, and some are running to the bathroom while others find using the bathroom increasingly difficult. Even low levels of stress can cause issues for the digestive system as the brain cannot easily run digestion while under duress.

During fight or flight, the enteric nervous system, which controls digestion, can shut down the digestive process. Yet even mild stress can cause issues such as indigestion, heartburn, nausea, diarrhea, and constipation. Even your immunity can decrease as the good bacteria in your digestive system tends to get flushed and your nutrient absorption decreases since things often move too quickly. Your metabolism will slow as well since blood is redirected to your brain causing a decrease in blood flow and oxygenation in your digestive system.

Our bodies are built to deal with certain levels of stress, and in fact this brain-gut link has aided in the survival of the human race, but the levels of stress that some people experience can have long-term effects. Experts agree that stress is a major factor in functional GI disorders such as IBS, where there is no clear physiological cause. And while stress does not cause IBDs such as Crohn’s and ulcerative colitis, it can certainly worsen and trigger symptoms.

Avoiding stress altogether would allow your digestive system the opportunity to function properly without interruption, but a more realistic goal is to try and manage your stress levels.

  • Prioritize
  • Limit your responsibilities
  • Take time for yourself
  • Start a journal
  • Try relaxation therapy (yoga, meditation, hypnosis), talk therapy (with friends, family, or a therapist), or cognitive behavior therapy
  • Avoid overeating and eating junk food
  • Avoid smoking and drinking alcohol

Stress can engulf us easily, and even the digestive side effects can be overwhelming creating even more stress and starting a vicious cycle. For those with GI concerns, controlling stress can mean controlling symptoms, so it is important to contact a gastroenterologist for advice.

Whether you are suffering from a gastrointestinal disease or chronic stress-related digestive issues, Dr. Cofrancesco and Dr. Quijano at GI North can help you diagnose, treat, and manage any of your digestive concerns. Located in Cumming, GA and serving the surrounding areas of Alpharetta, Roswell, Canton, and Suwanee, the professionals at GI North provide personal, specialized care with Dr. Quijano speaking fluent Spanish. Don’t put off talking to a professional, contact us and get some relief today!

© 2016 GI North Gastroenterology Services. All rights reserved.

photo of young woman in pain lying on bedThe definition of constipation is having difficulty in bowel movements or having a bowel movement less often than normal. The medical definition of constipation is having less than three bowel movements a week. Severe constipation is having less than one stool per week. In truth, going three days or more without a bowel movement is way too long. Actually after three days, stools are harder to pass.

You will feel a whole lot better when your system works properly. However, constipation is generally not a serious condition. Symptoms of constipation include:

  • Abdominal pain
  • Small or hard stools
  • Fewer bowel movements
  • Irregular bowel movements
  • Bowel movements are strained
  • Discomfort in the lower abdomen
  • Occasional distension or abdominal bloating
  • Feeling of unfinished emptying after bowel movements
  • Fissures or anal bleeding from the strain of passing hard stools
  • Possible worsening of hemorrhoids, diverticular disease and prolapse of the rectum

Causes of Constipation

According to WebMD, the causes of constipation are vast. Some of the reasons include:

  • Stress
  • Pregnancy
  • Eating disorders
  • Lack of exercise
  • Cancer in the colon
  • Irritable bowel syndrome
  • Eating too many dairy products
  • Changes in normal activities or diet
  • Not enough fiber or water in the diet
  • Hypothyroidism (under active thyroid)
  • Multiple sclerosis or Parkinson’s disease
  • Weakened bowel muscles from overuse of laxatives
  • Antacid medicines that contain aluminum or calcium
  • Issues with muscles and the nerves in the digestive system
  • Some medications like strong antidepressants, iron pills or pain meds


If you have problems with constipation for more than two weeks, it is recommended to see a specialist as soon as possible. Generally, a specialist will do a few tests in order to find the cause of your constipation. Some of the tests include:

  • Blood test to inspect hormone levels
  • Tests that look for colon blockages like a colonoscopy
  • Barium analyses to search for any colon blockages. It entails drinking a special concoction and then being X-rayed

At GI North, their expert practice offers focused care and advanced experience in the treatment and prevention of constipation. In fact, between the two professional physicians, they have numerous year of experience.

When to Call a Physician

According to most specialists, it is important to call a physician straightaway if you have sudden constipation that accompanies cramping or abdominal pain plus you are unable to pass a stool or any gas. Equally, call a physician if:

  • Stools are pencil thin
  • There is blood in your stool
  • Loss of weight without dieting
  • Constipation lasts more than two weeks
  • Constipation is not something you typically have

GI North

If at any time you have concerns or questions about your constipation, contact the professional staff or a physician at GI North. And for your upmost convenience, Dr. Cofrancesco and Dr. Quijano at GI North serve the Cumming, GA area as well as the surrounding areas including Alpharetta, Milton, Canton, Dawsonville, Roswell and Suwanee. Moreover, if you would like a Spanish speaking physician, you can request an appointment with Dr. Quijano.

© 2016 GI North Gastroenterology Services. All rights reserved.

image of a diagram of medicare | GI NorthFew would argue that budget cuts are necessary, but where exactly to make those cuts is vastly complex. For several years now, the Centers for Medicare and Medicaid Services (CMS) has been making cuts in an effort to avoid over payment as required by the Affordable Care Act. And while reducing overpayment sounds beneficial, the consequences often outweigh the savings.

In 2015, CMS proposed drastic cuts to reimbursement rates for colonoscopy and other lower GI endoscopy procedures. As you can imagine, there was much resistance to these cuts, but in the end, many of the proposed cuts were made cutting reimbursement for some codes as high as -16%.

These reductions focused on services provided in physician offices and freestanding facilities, which leaves hospitals to perform the procedures at the previous reimbursement rate. And, in some cases, rates were increased for hospital procedures.

At this point you might be wondering why you should care, and the truth is because these cuts could impact the quality of care available to you, as well as your choice of providers. Now in 2016, the physicians that perform colonoscopy are receiving up to 19% less for the procedure. This reduction in reimbursement will pose a challenge for physicians to continue to perform this life saving procedure.

Colon cancer is the third most common cancer in the U.S., and a colonoscopy is the most effective way of detecting and treating pre-cancer growths. Gastroenterologists are specialized in performing colonoscopy having a more focused training in comparison to a proctologist, yet gastroenterologists are the group of physicians directly affected by the cuts. Research continuously shows that gastroenterologists are less likely to miss potential concerns and less likely to undergo complications such as perforations.

Additionally, the National Colorectal Cancer Roundtable (NCCR) set a goal to increase screening rates for colorectal cancer to 80% by 2018, which could prevent 277,000 new cases of cancer and 203,000 deaths. While the NCCR has been making strides, reaching that goal with these new cuts poses a serious challenge since availability of screening facilities may decrease.

Every American after the age of 50 should undergo a screening for colon cancer every 10 years and many before that if high risk, so the question is who do want in charge of saving your life?

For those in the Atlanta area, GI North Gastroenterology Services offers excellent, specialized care with personalized attention. GI North is still accepting Medicare and performing quality colonoscopies. So if you are over 50 or carry one of the risk factors for developing colon cancer, contact our office. GI North is conveniently located in Cumming and serves the areas of Alpharetta, Roswell, Canton, and Suwanee. Dr. Cofrancesco and Dr. Quijano, who speaks fluent Spanish, are available to assist you with any gastroenterological need.

© 2016 GI North Gastroenterology Services. All rights reserved.


Stomach Upset Common Among Olympian Athletes

photo of olympic athlete holding torch | GI NorthAs the Rio 2016 Olympics began, hundreds of athletes from around the world converged on Brazil’s most vibrant city. Although the athletes’ village was built and managed with strict guidelines, many people who temporarily lived and worked in this area became ill. They complained of an upset stomach, which usually points to food poisoning. However, there’s a lot more to this story than just some bad food. With the help of GI North, take a close look at why Olympian athletes may have felt discomfort as they enjoyed the games.

Stress and Digestion

As many medical blogs will advise you, stress directly contributes to your digestive health. A person with many worries will often have stomach upset that interrupts his or her lifestyle. In many cases, reducing the stress is the only way to stop the digestive issues. Ideally, you should work with your GI doctor and general practitioner so that you can tackle all of these issues head on. Olympian athletes probably faced similar stress situations as they competed for gold, silver and bronze.

Acid Reflux Possibilities

Some Olympian athletes may have had an ailment referred to as acid reflux. It’s possible to have this disorder and not realize it without a professional’s guidance. The sphincter that controls the connection between the stomach and esophagus may loosen at times. Acid is allowed into the esophagus, which creates the sensation of an upset stomach. There are some treatments for this ailment, but the best solutions are often eating at a slower pace and choosing non-spicy foods.

The Leaky Gut Diagnosis

Most researchers agree that the majority of athletes were dealing with an issue referred to as leaky gut. This ailment is defined by the stomach’s mucous membrane and how it functions. Leaky gut means that nutrients cannot pass through the gut and into the bloodstream. As a result, the person feels a stomachache. This issue is most common in athletes when they exercise in hot climates. Rio’s climate and the games themselves make a leaky gut a probable cause for most stomach upsets.

Dealing With Stomach Upset

An upset stomach is a frustrating experience, especially for active people at the Olympics. Allowing the body to return to normal is the only real way to combat an upset stomach. Try to exercise in a cooler area with plenty of water to drink. Try to stay on the BRAT diet. This limited diet is meant to calm the stomach with bananas, rice, applesauce and toast. Other foods will need to be added to the diet, as the person feels better. Only time and a cooler atmosphere can reduce these unpleasant sensations.

If you’re concerned about your gastrointestinal system, contact GI North today. Both Dr. Quijano and Cofrancesco are pleased to serve the Cumming, GA, region. Dr. Quijano also speaks Spanish for your convenience. You can also visit them from other nearby towns, including Canton, Alpharetta, Suwanee and Roswell. When it comes to stomach upset, you want a solution as soon as possible. GI North can help you achieve a digestive balance.

© 2016 GI North Gastroenterology Services. All rights reserved.

In honesty, the possibility of needing to have a colonoscopy can be bothersome. No matter how you view it, just the thought of having one can be scary. However, a colonoscopy is a very safe test that has a minimal of risks. In fact, research shows that the risk of complications is extremely low at about 0.35 percent. Nonetheless, the risks are a bit higher with a polypectomy (removal of a polyp) at approximately 6 percent.

When there are complications they can include bleeding, perforation, an infection, reaction to the anesthetic and postpolypectomy syndrome. But studies show, the more a patient knows about a procedure, the less scary it seems. For more information about overall testing see “Taking the Scary Out of Colonoscopy


Many agree that the preparation of a colonoscopy is more difficult than the entire procedure. The good news is that once the prep is done, the rest of the procedure is easy. For the most part, preparation involves getting rid of the feces in the colon. However, the methods of preparation can differ. These vary from pills to taking liquids with or without an enema. But nonetheless, it is imperative that the bowels are cleaned out properly. That way the instruments can pass through the colon a lot easier and your physician can better examine for polyps or other irregularities. In addition, your physician or a specialist will know the best method of preparation for you.

How to Prepare

According to the Mayo Clinic, any residue in your colon can block a clear view of your colon and rectum during the exam. Your physician or a specialist may prescribe any of the following ways to empty the colon:

Laxatives – Your physician may recommend a laxative in liquid or pill form. Generally, the laxative is taken the night before your colonoscopy. Sometimes it is necessary to take the laxative the night before and the morning of the procedure.

Special Diet – Sometimes it is required that you sustain from solid foods the day before the exam. As well, drinks may be limited to only clear liquids such as plain water, broth and coffee or tea (without cream or milk). Also, red liquids need to be avoided because it can look like blood during the colonoscopy.

Enema Kits – Sometimes it is recommended that you use an over-the-counter enema kit to empty the colon. It is generally used the night prior to the exam or a few hours before the testing.

Adjusting Medications – It is best to remind your physician of the medications you take at least a week prior to the exam. This is especially important if you have heart problems, diabetes or high blood pressure or if you take supplements that contain iron. As well, make sure to tell your physician about aspirin or any other blood thinning medications that you take like rivaroxaban (Xarelto), clopidogrel (Plavix) or dabigatran (Pradaxa). Note: You may need to reduce or stop taking the medications briefly.

At GI North, Dr. Cofrancesco and Dr. Quijano define the procedure and how it is utilized to identify and prevent colon cancer. In addition, GI North can help you lower the risks of developing colorectal cancer. For instance, it is recommended that you have your first colonoscopy at age 50. However, earlier screening is advised if you have the following symptoms or conditions:

  • Polyps
  • Rectal bleeding
  • Unexplained weight loss
  • Abdominal discomfort or pain
  • A change in bowel movements
  • A family or personal history of colon cancer
  • A history of known genetic inflammatory colon cancer bowel disease

Contact the professional staff at GI North if you feel you need a colonoscopy or you have personal questions or concerns. GI North serves the Cumming, GA area as well as the surrounding areas of Alpharetta, Canton, Roswell and Suwanee. In addition, Dr. Quijano speaks fluent Spanish.

© 2016 GI North Gastroenterology Services. All rights reserved.

medical illustration showing a colonoscopy | GI NorthConferring to WebMD, a colonoscopy is a test that enables a physician to view the inner lining of your large intestine (colon and rectum). The test involves a colonoscope to allow inspection of the colon, which is a pliable and thin tube that is around 48 in. (125 cm) to 72 in. (183 cm) long. In fact, a physician can inspect the whole colon and the lower part of the small intestine with the use of the device.

Moreover, the test aids in finding tumors, ulcers, polyps and areas of bleeding or inflammation. The biopsy can involve collecting tissue and the removal of abnormal growths. As well, a colonoscopy can help with screening for cancer or pre-cancerous growths in the rectum or colon.

ASGE Quality Indicators

One of the chief priorities for the nation’s prominent gastrointestinal endoscopic healthcare association is identifying quality standards and defining measurements in administering colonoscopic care. As of late, the American Society for Gastrointestinal Endoscopy or ASGE identified objective processes in relation to colonoscopy (April 2006). In fact, the measurements and guidelines greatly assist endoscopists with assessing and refining their performance.

Effective colonoscopy entails thorough and cautious mucosal inspection so that the cancer mortality is lowered and colon cancer is prevented. ASGE quality indicators are used to measure the performance of colonoscopy so that a better outcome is achieved. It also rates the level of evidence in support of each quality indicator. For the three stages of a colonoscopy there are quality indicators: Preprocedure, Intraprocedure and Postprocedure.


The preprocedure quality indicators for colonoscopy include numerous concerns that impact the patient and endoscopic team. Prior to admin of insertion or sedation of the endoscope, these common issues are taken into consideration.

  • Correct Indications – Once information is obtained or the therapy delivered will help the patient, endoscopy is indicated.
  • Informed Consent – Consent and approval is first acquired and documented for the procedure. As well, analgesia and sedations are provided except in emergency situations. Approval and consent should include common complications such as perforation, bleeding, sedation-related complications and missed diagnosis.
  • Preparation – It is essential that there be impeccable documentation of the quality of the bowel preparation so that screening is successful. Measures for precision should include poor, fair and excellent.


The intraprocedure quality indicators are comprised of three main areas: Cecal intubation, detection of adenomas and withdrawal time.

Cecal intubation – The visualization of the cecum by noting the landmarks and the photo-documentation of landmarks should always be documented in each procedure. As well, the entire cecal caput that includes the medial wall of the cecum between the ileocecal valve and appendiceal orifice should be visible. The necessity for cecal intubation is established by the continual finding that contains a significant fraction of colorectal neoplasms located in the proximal colon as well as the cecum. Moreover, visualization of this area is vital for preventing colon cancer.

Detection of adenomas – Expertise is critical when it comes to the finding of adenomatous polyps (benign premalignant tumors) in asymptomatic patients that are undertaking screening colonoscopy. In fact, studies indicate that the colonoscopy discoveries by gastroenterologists and endoscopists are much more accurate that the tests done by non-gastroenterologists or interns. Plus, there is a top-quality examination of colonic distention, mucosa proximal to folds and flexures and superior cleaning of fluid and debris from the colon.

Withdrawal time – The total time spent inspecting the colon while removing the colonoscope can be a fitting quality indicator. Actually, longer times are connected with larger findings of neoplastic lesions. In fact, prevalence rates of adenomas in screening are greater than 25% in men and 15% in women over 50 years old. What is more, doctors who spend more than six minutes of withdrawal time had a much higher detection rate of adenomas compared to those who had less than a six minute average.

Other intraprocedure regions consist of patients going through ulcerative colitis, biopsy samples from patients with chronic diarrhea and Crohn’s disease analysis.

GI North

If you suspect that you may have any kind of colon issues it is always best to schedule an appointment with a specialist. In fact, you can set up a one-on-one appointment at GI North to talk over any specific treatment or procedure you may be contemplating. Both Dr. Cofrancesco and Dr. Quijano are renowned for their expertise and experience. As well, Dr. Quijano fluently speaks Spanish.

GI North is located in Cumming, GA and also serves the surrounding areas: Alpharetta, Canton, Roswell and Suwanee.

© 2016 GI North Gastroenterology Services. All rights reserved.

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