Colonoscopy

No doubt about it, a colonoscopy can be a humbling experience. And no doubt, that's the primary reason why an alternative procedure (no "tubing" required) is so appealing. An exterior scan method called computed tomographic colonography (CTC) has developed a reputation as a "virtual colonoscopy," as if it were one of those many remarkable applications available on the newest Apple iPhones. Unfortunately, colon cancer diagnosis hasn't quite progressed to the personal handheld device stage. A new study in the Journal of the American Medical association shows that CTC was almost as effective in spotting advanced lesions compared to traditional optical colonoscopy (OC) in a comparison of more than 1,000 patients. But a previous study reveals why that "almost" is not the only worrisome problem with CTC.

In a 2007 study that appeared in the New England Journal of Medicine, researchers at the University of Wisconsin compared 3,163 patients who underwent traditional OC to 3,120 patients who were examined with the CTC technique. RESULTS: In the CTC screening, 123 advanced tumors were found, compared to 121 in the OC group Total polyps removed in the CTC group: 561 Total polyps removed in the OC group: 2,434 Seven perforations of the colon occurred in the OC group compared to none in the CTC group

Researchers concluded: "These findings support the use of CTC as a primary screening test before therapeutic OC." The risk of a perforated colon is a clear drawback for OC, but those two bullet points regarding the total polyps removed are very revealing. Why are the numbers so lopsided? Because all polyps are routinely removed on the spot during OC, but when polyps are detected in the CTC group, patients are given the option of leaving very small polyps in place or undergoing an additional OC procedure to remove the polyps. In the UW study, about eight percent of the patients underwent follow-up OC after undergoing CTC. Given the pros and cons of CTC mentioned above, a patient might still choose the newer method believing it's noninvasive. But that's not quite the case.

In CTC there's an invasive moment at the beginning of the procedure when a catheter is inserted into the rectum to fill the colon with air. Given the choice between air and a tube, most people would probably choose air. But I know of at least one patient who wouldn't recommend it. Somebody shared this account of a friend's CTC procedure: "I thought I was going to just have a CT scan. NO, NO. You have to pump yourself up with air so that they can take the pictures. Filling yourself up with air is indescribable. I thought I was going to blow off the gurney. It takes 7 minutes all told but it was the longest 7 minutes I have ever gone through. "It has been one week since the test and my stomach is still very large and hard. I am sure that there is still air in there. God knows how long this lasts. It also makes it difficult to eat as you feel full very quickly. So all I can say is never, never again would I do this." In addition to the air-pump discomfort, there's one more caveat: CTC is a powerful xray technique that requires a radiation exposure quite a bit higher than a standard chest x-ray. Of course, excessive radiation exposure increases cancer risk, so this is a factor that patients need to discuss with their doctors.