Doctors making gains with less pain

Colonoscopy: Virtual technology shows promise as an alternative to the dreaded but often lifesaving procedure.

Medicine & Science

December 08, 2003|By Dennis O'Brien | Dennis O'Brien,SUN STAFF

Colonoscopies can save people from the second most lethal form of cancer, one that kills an estimated 59,000 people each year.

But they're a hard sell for patients.

The test requires purging the intestines with a diarrhea-inducing potion, being put under anesthesia and having a tube with a lighted camera inserted in the rectum and colon. Patients spend two to four hours recovering, must be driven home and miss a day of work.

"The anticipation is much worse than the actual procedure," said Dr. Jean-Pierre Raufman, chief of gastroenterology at the University of Maryland Medical Center, who had a colonoscopy two years ago.

So it's no wonder that only a third of those who should have the test bother with it and that researchers are trying to find a replacement. Doctors recommend it for everyone over 50.

Lately, scientists seem to be making inroads.

Researchers are testing a process developed at the Johns Hopkins Kimmel Cancer Center that can detect colorectal cancers by finding genetic signals in patient stool samples. The process, announced last year, is the focus of a study of 5,000 patients by a Boston-based company that licensed the technology.

Last week, researchers announced that a new technology, known as virtual colonoscopy, showed promise. Their findings, based on tests on 1,350 patients showed that virtual colonoscopy was just as reliable as traditional colonoscopy, spotting the most dangerous lesions in the colon 94 percent of the time.

The results are so convincing that the Department of Defense plans to replace traditional colonoscopies with virtual colonoscopies at all military and Veterans Administration hospitals, said Lt. Col. J. Richard Choi, a radiologist at Walter Reed Army Medical Center who co-wrote the study.

He said that in East Coast military hospitals alone, that will translate into about 25,000 virtual colonoscopy procedures each year.

Choi said that virtual colonoscopy patients must undergo the same intestinal purging process but that the test itself is cheaper and faster. Virtual colonoscopy means no sedation, patients avoid the two to four-hour recovery and can drive themselves home.

A traditional colonoscopy costs $1,500 to $2,000. The virtual procedure - while not yet covered by insurance - runs about $500, he added.

In the virtual test, a catheter about the size of a small finger is placed in the rectum to slowly inflate the colon. CAT scans are then run with the patient on his side and back. Each scan takes about 15 to 20 seconds, he said.

But the technology has yet to win the endorsement of the American Cancer Society. Dr. Durado Brooks, the organization's director of colorectal programs, noted that if a virtual colonoscopy detects a threatening lesion, a traditional colonoscopy must be performed to remove it, which puts the patient through the process twice.

But supporters of the technology think the Cancer Society will soon endorse it - and insurers will pay for it - if more studies confirm its accuracy.

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