Last year, my friendly internist told me it was time for my periodic colonoscopy. I have had several colonoscopies and barium enemas (BEs). I am well aware that the prep makes the night before among the most miserable evenings most of us endure in our adult lives.
“How about a virtual colonoscopy instead?” I asked. “My radiologist friend’s group is doing them. He tells me that he had one, and it was less traumatic than the endoscope making its way against the tide.”
“The prep is just as bad,” replied my doc. “With the endoscope, you can sample or even remove polyps. If you get a positive finding on the virtual form, you will need a second prep for the real thing. Besides, I am not convinced that the virtual one is as reliable as the real thing.”
I asked other doctor friends, including several radiologists. To my faint disappointment, even the radiologists urged the real thing. Why? Because of the biopsy potential.
From my years in defending your turf, I knew that the knights of the endoscope had denounced BEs. Because they got to do the colonoscopies, we protested that their motivation was as much financial as scientific. A few years ago, when Congress was persuaded to add colon screening as a Medicare benefit, gastroenterologists spent as much effort and money denouncing BEs as they did arguing for their form of colon screening.
Last summer, virtual colonoscopy got a general endorsement in a joint guideline from the American Cancer Society (ACS), the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology ( ). The working group included radiologists Beth McFarland of Washington University, Seth Glick of the University of Pennsylvania, and Perry Pickhardt of the University of Wisconsin.
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References
1. Levin B., Lieberman D.A., McFarland B., et. al., American Cancer Society Colorectal Cancer Advisory Group, the US Multi-Society Task Force, and the American College of Radiology Colon Cancer Committee: Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. CA Cancer J Clin 2008; 58: pp. 130-160.
2. Johnson C.D., Chen M.-H., Toledano A.Y., et. al.: Accuracy of CT colonography for detection of large adenomas and cancers. N Engl J Med 2008; 359: pp. 1207-1217.