The Difference Between a Gastroenterologist and a Colorectal Surgeon

Do you know what the difference is between a gastroenterologist and a colorectal surgeon? While we treat many of the same conditions there are some inherent differences in these two specialties. Knowing this difference will guide you to the right specialist.

A colorectal surgeon, may also be known as a proctologist. That’s what I am. To become a colorectal surgeon, you must first become a general surgeon, which includes 5 years of surgical residency after medical school, where you learn how to do all sorts of surgeries from gallbladder surgery, hernia surgery, breast surgery, and even vascular surgery. You then do an extra year of specialty surgical training in colon and rectal surgery to become an expert in surgery for the colon, rectum and anus treating everything from hemorrhoids and anal fistulas to colorectal cancer, inflammatory bowel disease, diverticulitis and pelvic floor disorders.  During that time you also learn to perform colonoscopy and endoluminal procedures. Many colorectal surgeons practice both general surgery and colorectal surgery, and some choose to specialize only in colorectal surgery (me), despite being board certified in both.

Gastroenterologists, on the other hand, first complete 3 years of medical residency, learning to care for all medical conditions from diabetes and heart disease to pneumonia and rheumatoid arthritis. They then do 3 years of specialty training in the medical management of gastrointestinal diseases and learn to do colonoscopy and endoscopy. Some do an extra year of training in inflammatory bowel disease, liver disease, or advanced endoscopy as an example. While most GI doctors do endoscopic procedures they don’t don’t operate on patients. So a small polyp found at the time of your colonoscopy by a gastroenterologist may be removed by your GI doc, but if you have a polyp that is so large that it can’t be removed endoscopically, you may be referred to a surgeon. You will also be referred to a colorectal surgeon if you have a colon cancer.

While the conditions that colorectal surgeons and gastroenterologists treat may overlap (we both may do colonoscopies for example) there are some key differences in the treatments we offer by trade, and some may be provider- or institution-specific.

1. Colorectal surgeons, generally don’t treat stomach, pancreas, liver disease – gastroenterologist do. If you need a surgeon for those conditions, they may refer you to a surgeon specialist in those areas.
2. Since Irritable Bowel Syndrome (IBS) is never a surgical condition, that’s also in the GI realm.
3. Colorectal surgeons also generally don’t employ medical treatment of inflammatory bowel disease – that’s generally done by GI in the US and a referral to surgery is made only when the condition is bad enough to need surgery.
4. Colorectal surgeons often do more than just surgery, especially when it comes to anal disease. We offer non-surgical approaches to hemorrhoids and anal fissure and only if the condition gets serious enough do we escalate treatment to surgery.
5. The breadth of treatments we offer from office based to surgical allows us to choose the best treatment based on your condition, not simply due to a lack of expertise in surgery.

I hope this post helps clarify any confusion about these specialties and helps get you to the best provider for your condition. If you are unsure who you should be seeing, it’s best to ask before you make you appointment to avoid any confusion or disappointment at the time of your consultation!

Author

Karen Zaghiyan, MD