Hunting for Polyps
By Rear Adm. Joyce Johnson, D.O., M.A.

I just turned 50, and my doctor recommended a colonoscopy. Is it as bad as people say? What about a “virtual” colonoscopy?

Each year about 135,000 new cases of colon cancer are diagnosed, and about 55,000 Americans die of colon cancer. By the time symptoms of colon cancer appear, it often is advanced and difficult to treat. Colonoscopy is a very effective procedure to identify and remove polyps in the colon before they become cancer.
 
Opinions differ on routine use of colonoscopy in people without symptoms. It often is recommended if there is a change in bowel habits, unexplained chronic diarrhea, constipation, abdominal pain, blood in stools, anemia, or suspicion of colon polyps or cancer. Some physicians recommend it for everyone over 50.

Your colon must be clean during a colonoscopy to give the physician a clear view. Typically, “bowel prep” involves drinking a gallon of a special, flavored laxative solution the night before. You will receive an intravenous sedative and pain medication before the procedure begins. Then your doctor will insert a flexible fiber-optic tube called a colonoscope into your rectum. It is about half an inch in diameter, as long as the colon, and has a micro-camera at the tip. Because of the medication, you will hardly feel it. A small amount of air is used to expand the colon and make it easier to see the colon wall. If polyps, other small growths, or abnormally inflamed tissue are found, they often can be removed during the procedure for further examination. Removing polyps during a colonoscopy often is the only treatment needed. A complete procedure takes about 45 minutes, after which you should stay in the recovery area until the medication wears off. Arrange for someone else to drive you home.

“Virtual” colonoscopies use ct scanning to get a visual image. They are faster and don’t require any sedative or pain medication, but they require the same bowel prep as a regular colonoscopy. They also involve insertion of a tube into the rectum to blow in air and expand the colon. Although virtual colonoscopies are indicated for some patients, they cannot identify as many small polyps as regular colonoscopies. If a virtual colonoscopy finds any polyps, you will need a regular colonoscopy to remove them.

Colonoscopies can be expensive. Ask your doctor if a colonoscopy is needed, and then check with your insurance company to see under what circumstances colonoscopies are covered before scheduling one. To learn more, visit the Web site of the American College of Gastroenterology, www.acg.gi.org.