Anyone who has ever had a colonoscopy (and if you are over 50, we hope you just raised your hand), walks away from the experience wondering, "Why isn't there a better way?" Well, it turns out there just may be, but some within the medical community at-large have been slow to embrace it for one reason, which we'll tell you later. First, let's start with why CT colonographies -- more commonly known as virtual colonoscopies -- beat optical colonoscopies hands down. And a hat-tip to Drs. Joel Bortz and Joseph Lebovic of LSG Imaging for enlightening us:
The doctor can see more with a virtual colonoscopy.
In a traditional colonoscopy, what is being examined is your intestines. A 5'7" scope with a camera on it is manually inserted through your rectum and the doctor can see and take photos of what the scope passes as it is is slowly pulled out. It sees things in one direction only and there is no doubling back.
In a virtual colonoscopy, your body passes through a CT scanning machine. You are flipped over and scanned from lung to pelvic area twice in both directions. Bortz said that in his practice, the lung to pelvic scan has led to the detection of many issues outside the intestines: pancreatic cancers, kidney stones, cysts in the liver, gallstones, lung cancer, and kidney obstructions -- all in patients with no symptoms. The early detection of cancers improved the patients' survival rates.
So yes, you come for a colo-rectal cancer check and leave knowing that you have some other health problem -- but we see that as an added value.
The prep involved in a virtual colonoscopy, while still unpleasant, is definitely less so.
In an optical colonoscopy, you must cleanse your intestinal tract as thoroughly as possible because the doctor is going to literally look at your innards through a camera. This thorough cleansing is accomplished by drinking clear liquids the day before and using industrial strength laxatives. By the time you stagger into the colonoscopy center the next morning, you are feeling drained, dehydrated, and exhausted from having to run to the bathroom all night. Most people at this point can't wait to just be anesthetized and get the whole thing over with.
The prep for a virtual colonoscopy is less rigorous, inasmuch as you drink about a third less of the über-laxatives. The virtual test includes drinking a small amount of barium sulfate suspension and Gastrografin. These potions help the radiologist identify pools of liquid in your intestines as well as highlight any abnormalities. Still unpleasant, but better.
There is no need for anesthesia in a virtual colonoscopy.
There is no need for an IV, no one poking you to find a vein. In fact, there is no need for you to be put to sleep. A virtual colonoscopy is a painless procedure. You can drive yourself there and home; no need for a chaperone. If you want, you can go to work afterward.
President Barack Obama opted to have a virtual colonoscopy. When President George W. Bush had his done optically, it was necessary to transfer the power of the presidency to Dick Cheney for the hours Bush was incapacitated.
Optical colonoscopies claim a full day of your life. CT colonography takes mere minutes on the table.
Virtual colonoscopies are less invasive, so therefore there is less risk of infection.
In an optical colonoscopy, the scoping equipment enters your body. That means it needs to be super sterile, which apparently isn't always the case. Three out of 20 flexible gastrointestinal (GI) endoscopes used for screening were found to have unacceptable levels of "bio dirt" -- cells and matter from a patient's body that could pose potential infection risk, according to a study of endoscopes used at five hospitals across the U.S. and reported in Medical News Today last year.
There have been reports of improperly cleaned endoscopes at healthcare facilities across the country, including the Veterans Administration, in which thousands of patients required testing for HIV and hepatitis B and C. According to the Centers for Disease Control and Prevention, which published guidelines for reprocessing endoscopes in 2008, more healthcare-associated outbreaks have been linked to contaminated endoscopes than to any other medical device, said the report.
While it's relatively rare, a few years ago an endoscopy center in Las Vegas was targeted by the CDC for routinely failing to practice the basic standards of infection control that led to a deadly hepatitis outbreak. The doctor involved was sentenced to life in prison and his clinics shut down. About 64,000 patients were urged to get tested for blood-borne viruses after the news broke.
By comparison, Bortz noted, virtual colonoscopies are minimally invasive. A small soft flexible rubber catheter is inserted into the rectum and inflated with CO2. The CO2 is immediately absorbed from the colon. In an optical colonoscopy, a semi-flexible tube that is 5'7" is inserted into the rectum and pushed manually to the cecum.
Bortz says the radiation from the CT scan in a virtual colonoscopy is minimal and falls well within the acceptable limits for annual background radiation. There is no radiation involved in an optical colonoscopy.
Polyps, which sometimes can be pre-cancerous, can also be much ado about nothing.
One advantage of the optical colonoscopy is that if the doctor sees something suspicious, he can take a sample for a biopsy right then and there. Polyps, both small and large, are removed right on the spot. According to Bortz, small polyps should be left in the colon and followed up in three years (though other experts in the field argue that cancer can sometimes develop in small polyps, and that not removing these polyps could actually increase deaths, according to a decision analysis from Massachusetts General Hospital).
What happens if larger polyps are spotted on the virtual scan? "We walk over to the phone and arrange to have the patient followed up with an optical exam," Bortz said.
So why isn't everyone rushing to get a virtual colonoscopy? There's one simple reason, believe Bortz and Lebovic: Money.
There is a lucrative medical industry built around doing things "the old way," said Bortz. Both he and Lebovic are radiologists. The doctors who perform optical colonoscopies are gastroenterologists, and anesthesiologists must also be present. The laboratory that analyzes the samples is also paid. So are the facilities where the procedures are performed, which in many cases are owned by the same doctors performing them. The larger medical community -- medical schools -- are also vested in training doctors to do the procedure.
Obviously, patients should discuss any concerns or questions they have with their doctor. The debate over which procedure is better has been going on for quite a while. Back in 2009, the MD Anderson Cancer Center published this back and forth.
LSG Imaging charges $975 for a virtual colonoscopy. While increasingly, the trend is for insurance companies to pay for it, some still do not. Currently, the insurance commissioners of 22 states require insurance companies to cover virtual colonoscopies as a condition of being able to operate in those states.
Obviously you should talk with your own doctor for answers to any questions you may have about what type of colonoscopy is right for you.
CORRECTION: A previous version of this article incorrectly stated that a doctor using a colonoscope can only see and photograph images as the scope is being withdrawn; in fact, the colonoscope can move back and forth. The article also incorrectly reported that a recent paper found 15 percent of colonoscopes used in optical colonoscopies did not pass a test for cleanliness. That percentage was in fact 3 percent. A previous reference to a German study on the mortality rate of patients undergoing general anesthesia has been removed, as general anesthesia is not routinely used for colonoscopies.