Bryan Arling: Is Virtual Colonoscopy as Good as Standard Colonoscopy?

I have heard that a virtual colonoscopy is a simple X-ray procedure. What would you advise someone who is dreading getting a colonoscopy?

Bryan Arling: Most studies compare polyp detection rates, which are equivalent [between the two types of tests]. But I think visual inspection through [standard] optical colonoscopy should provide higher detection of "flat lesions" while also allowing the gastroenterologist to remove polyps and biopsy other lesions. Plus, the radiation from a virtual colonoscopy is the equivalent of several hundred chest X-rays, [and] many radiologists will fill the colon with air, a process which can be uncomfortable.

On the other hand, virtual colonoscopy can be enormously helpful if a gastroenterologist hasn't been able to successfully perform colonoscopy because of a large, redundant colon that has multiple twists and turns or because a patient has old scars binding loops of bowel together. I have had one patient with a strong family history of pancreatic cancer and another patient with a family history of lymphoma who elected to have virtual colonoscopy at age 50 because the procedure allows us to look at the pancreas and lymph nodes outside the colon, and they were young enough to be unlikely to have polyps that would require a follow-up colonoscopy anyhow.

Whichever screening test is used, the bowel prep is critical for a good examination. (Some people will walk in off the street to get total body CT scans, but these virtual colonoscopies are not as reliable if a person hasn't gone through the same bowel prep as one used in colonoscopies.) For my patients, I have found that the polyethylene glycol solutions are less likely to cause nausea, abdominal discomfort, and abdominal distention if one begins the prep far enough in advance of the colonoscopy that one does not need to drink 8 ounces every 10 minutes. Also, I recommend that my patients keep the liquid at room temperature because if it's chilled, it's like eating ice cream or snow cones too quickly, and that increases abdominal discomfort.

Before having a colonoscopy, talk with your gastroenterologist about your preference for minimizing or maximizing tranquilizing medications used during the procedure, and be aware that some data suggest that more polyps, cancers, and other pathologies are found if the gastroenterologist takes a little more time in doing the procedure. For routine screening colonoscopies, outpatient facilities are just as safe as having procedures performed in the hospital. For older patients or for those who have coexisting medical problems, such as known bleeding or anemia that might increase the risk of colonoscopy, or for those who cannot complete the preparation by themselves at home, hospitalization should be considered.

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