What is a colonoscopy?

Study of lining of colon and rectum by a gastoenterologist

Major step towards preventing colon cancer!

Colorectal cancer 2nd leading cause death by cancer in US

1 in 20 adults will develop colon cancer

Colonoscopy more accurate than all other methods to detect polyps and early cancer

Simpler than exploratory surgery

How often do you need to have test?

If no cancer or positive finding - 10 years

If cancer or positive finding - 5 years

Discontinued after 75 if no findings previously

Long, thin, flexible instrument connected to camera and video display monitor

Inserted into rectum and up to T.I.

Colonoscope

Colonoscopy recommended if:

• bowel habits change

• blood in stool

• persistent abdominal pain

• patient is aged 50 years or older

Colonoscopy vs. Sigmoidoscopy

Colonoscopy inserted into rectum-moved through entire colon

Sigmoidoscopy- inserted into rectum-final 2 ft colon

Sigmoidoscopy

• No drugs!• Major pain and cramping

Colonoscopy

• Good drugs!• No cramping

Colonoscopy vs. Sigmoidoscopy (cont’d)

Polyps

• Benign growths on inner wall of colon

• Size: pinhead to several inches

• Painless• Slow growing- years before

become aggressive cancer

Polyp cont’d

If encountered-

thin wire snare is used to lasso it or

electrical heat (electrocautery) applied to remove painlessly

Some may disappear on own

Colonoscopy (cont’d)

• Takes less than an hour

• Mild sedation - relieve anxiety and discomfort (someone must drive you home)

• Often not remembered by pt.• • May experience bloating- will

quickly improve.

• Can resume eating a regular diet later that day

PrepSimilar to BE and ACBE

Low residue foods 2 day before

Eat jello, drink clear liquids day before AM appt.

Afternoon before:laxative gallon of liquid (Golytely) glass every

ten minutesStarve

AM appt.!

Advantages over Barium Studies

• No x-ray!

• Can perform polyp removal, tissue sampling during study

• More accurate than BE, pneumocolon

Virtual Colonoscopy (VC)

(aka: CT Colonography)

What is a VC?

• Study 1st introduced 1994 as alternative to regular colonoscopy

• Uses CT scanner (sometimes MRI) to produces 2 and 3 dimensional images and video

• Looks for signs of precancercous growths (polyps), other diseases of large bowel

VC

Advantages of Virtual Colonoscopy over previously accepted forms of determining colorectal cancer

• Less rigorous bowel prep• short procedure – 15- 20 minutes• no sedation or anesthesia• no invasiveness-no scope- thus more compliance! (thin tube

to pump air to inflate colon)• no risk of perforation of colon• more complete exam of colon (often can’t reach end-

blockage, redundant bowel with conventional colonoscopy

• Faster- more pts can be done ($$$)

Besides colon you see:

• liver• gallbladder• pancreas, spleen• kidneys, adrenals, lymph nodes

organs • uterus• ovaries • prostate• assessment of aorta to exclude

aortic aneurysm

Disadvantages - Virtual Colonoscopy over Colonoscopy

Cannot remove polyps!

Uses radiation

Pt. confined in tight area

Cost

Much cheaper than standard colonoscopy ($800 vs $3,000)

But Insurance companies won’t pay for routine diagnostic VC exam: