I've had a j-pouch for about six years now and have had almost no problems at all (and I count myself as very blessed!). It sometimes seems like a waste of money to have an endoscopy every year. After insurance it typically costs me about $700. If I'm having no problems, is it foolish to move toward being scoped every two or three years?
Just curious what everyone's opinion is. I know what my GI would say, of course. But I know there are some very knowledgeable people on this forum as well.
Replies sorted oldest to newest
If you have any kind of pre-dysplasia or dysplasia of any kind pre colectomy or on colectomy pathology, they advise surveillance annually. We are also at a slight risk still for cancer in the remaining rectal cuff so that is why they like to continue with annual surveillance. Finally, for those of us with chronic pouchitis, cancer of the pouch is probably not likely but there are reports of it occurring.
I'm down to 3-5 years between scopes unless there's a problem to clarify. I agree with Jeanne's description.
You might be pleasantly surprised by your GI's opinion.
I agree. This should be a case by case decision. My GI does not scope by a set schedule (other than every few years). I've had plenty of scopes, but only for diagnostic purposes, and every 2-3 years when things are stable. Naturally, if you have a history of dysplasia or cancer, your monitoring will differ.
Opinions do vary. Of course, you can get an annual scope "for piece of mind," but there are practicalities too. Overtreatment is part of what drives up the cost of health care (even if your copay is low).
Jan 
if your dysplasia was in the part of large intestine that was removed completely, why would you still need to be monitored more often?
Mine was first noted as dysplasia then when pathology report was complete, it turned out to be hyperplasia. Would this be considered a pre-dysplasia and if so would I need more frequent scopes? Just wondering.
CT, you probably really had both dysplasia and hyperplasia, at various times, as these things can come and go without pathologist errors. With your history I'd tend to be more careful, reducing the time between scopes to a year or two. The rectal cuff is a much smaller target than a whole colon, but it's still a target.
Perhaps you could have a frank financial discussion with your GI. A pouchoscopy without sedation takes very, very little time, and perhaps he/she could price it more reasonably.
Thank you all for your input - this is very helpful. I truly appreciate having this forum as a resource.
Thanks, Scott. I will have my first this summer and expect to pay 20% of the contracted amount with Tricare. The first will be with my surgeon and I am hoping he will do them for a little while before I have to find a GI that I have confidence in. My last GI doctor and I have parted ways due to his non aggressive treatment of my case. I will also be eligible for Medicare and Tricare for Life 2 years from October so hopefully this will cover most of the cost.
Poucho,
Even if your dysplasia was in a removed part of your gut, you still have the history. This means that your genetics are such that you are at more risk than someone who never had any evidence of dysplasia.
Jan
