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Colonoscopies could be made a bit more comfortable for people if they involved lying in a CT scanner, rather than being probed with an endoscope, and at the same time didn't require drinking upward of a gallon of laxative fluid beforehand — current requirements that most consider unpleasant.
A new type of "virtual colonoscopy" that uses CT scans to construct images of the colon, as well as to virtually "clean" the organ, was just as effective as a standard colonoscopy in finding colon polyps 1 centimeter or larger in size, a new study finds. Most polyps, or growths on the lining of the colon, are benign, but some can turn cancerous.
"The subtraction of the laxative can only make what's already an attractive test even more attractive," said Dr. Durado Brooks, director of prostate and colorectal cancer at the American Cancer Society, who was not involved with the study.
The discomfort of colonoscopies may deter some people from getting screened, said study researcher Dr. Michael Zalis, an associate professor of radiology at Massachusetts General Hospital.
If this laxative-free, CT scan type of virtual colonoscopy becomes an option for colon cancer screening, Zalis said, it could increase the number of people who get screened, and thus reduce the number of deaths from the disease.
The laxative-free method was not as effective as a standard colonoscopy in finding polyps smaller than 1 centimeter, but polyps of this size are less likely to cause cancer, according to the National Institutes of Health. The new findings must be confirmed by larger studies before the test is put into practice, Zalis said.
The study is will be published Tuesday (May 15) in the journal Annals of Internal Medicine.
No laxative required
Each year, there are about 120,000 new cases of colon cancer in the United States, and 50,000 people die from the disease,Zalis said.
Several methods are available to screen for colon cancer, including blood and fecal tests. But the "gold standard" is the colonoscopy, and the type most commonly performed is the optical colonoscopy, which uses a fiber optic tube with a light and camera to examine the internal surface of the colon. Another method, computed tomographic colonography (CTC), uses images produced by CT scans to indirectly view the colon. Both methods require patients to drink a laxative the day before their procedure.
More than 90 percent of colon cancer screening is done with colonoscopies or the blood tests, Brooks said.
In the new study, 604 people ages 50 to 80 who were eligible for a colonoscopy received the new test — a laxative-free CTC. Participants were required to eat a low-fiber diet for two days before the procedure, and to ingest small doses of a contrast agent that labeled their stool so that it was distinct from the colon on an X-ray. About five weeks later, the same patients were given an optical colonoscopy.
The laxative-free CTC correctly identified 91 percent of people with polyps 1 centimeter (10 millimeters) or larger. The results for the optical colonoscopy test were similar; it identified 95 percent of people with polyps of this size.
However, the colonoscopy was better at finding smaller polyps: it correctly identified 76 percent of people with polyps 0.6 centimeters or larger, while laxative-free CTC identified 59 percent of people with polyps of this size.
Three cases of colon cancer were diagnosed in the study. These cases were detected by both screening methods.
Participants said the laxative-free method was more comfortable and easier to prepare for than the colonoscopy. Sixty-two percent said the laxative-free method was their preferred method of screening.
Not a 'game changer'?
While laxative-free screening might increase the number of people who get colon cancer screening, "I don’t think it will be the big game changer that [the authors] suggest," said Dr. John Monson, chief of the division of colorectal surgery at the University of Rochester Medical Center, in New York, who was not involved in the study.
There are many reasons people do not get screened for colon cancer besides the requirement of a laxative, Monson said. For instance, some find other aspects of the test not agreeable, and others may be frightened to know the results, he said.
All virtual colonoscopies have a disadvantage in that, if polyps are found during the test, a follow-up colonoscopy is needed to remove them, Monson said. In addition, while polyps larger than 10 millimeters confer the greatest risk of colon cancer, most doctors do not feel comfortable leaving behind polyps that are 0.6 centimeters in size, Monson said.
CTC is currently considered an accepted method of screening by the American Cancer Society, but not by the U.S. Preventative Services Task Force.
The ACS recommends that people who get virtual colonoscopies be re-screened in five years; those who get optical colonoscopies are recommended to wait 10 years between tests.
Zalis said laxative-free CTC might first be offered to people who have only a moderate risk of colon cancer (those 50 and older without a family history of the disease, or other risk factors, such as inflammatory bowel disease). Some people may also be unable to have a colonoscopy, for instance, if they cannot be sedated for a medical reason.
While CTC uses X-rays, the dose is much lower than that required for a CT scan used to diagnose disease, Zalis said. A study published in 2005 published in the journal Gastroenterology concluded the cancer risks associated with exposure to radiation from CTC are small.
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I've always had the feeling that these downright violent laxatives are probably irritating the daylights out of your digestive tract, and may be doing more harm than the polyps. I suspect that someone will eventually do a study and discover that people exposed to these laxatives have a measurably higher risk of developing intestinal cancers.
I can see the TV ads now: "If you or a member of your family suffered serious injury or died as the result of cancer caused by exposure to laxatives, you may be entitled to compensation. Contact the law offices of...."
Don't know about increasing the risk of cancer but it sure caused my 'roids to flair up.
I think that the dose of radiation (X-rays) that you receive for a CT-scan increases your chance of developing cancer more. Personally, I'll get the laxatives.
EarlyOut - you just go with that thought, avoid colonoscopies because you are afraid of the laxatives, and see whether dying from colon cancer is less irritating or painful.
So to put the numbers in perspective - about 3,000,000 people die per year and only 50,000 of them are due to colon cancer. Thanks but no thanks - I'll take my chances and forgo both tests and save the cost of the testing!
There are now pills available to take instead of that horrible liquid. My friend had it done recently. She had to pay extra (about $90 out of pocket) for the pills, but said it was well worth it because she throws up the liquid.
I doubt they could do as much harm as an undetected, and unremoved, pre-cancerous, or cancerous growth.
As the article points out, if they find anything then you have to go through the regular process, and at greater cost. So why not grin and bear it and get it overwith?
How can you call if you died?
Yeah, and the attorneys would get MILLION$$, and all you'd get is COUPONS! ......For a discount on your next COLONOSCOPY!!
Wow, after numerous times of having to drink
that awful gallon jug of grossness, I say try the new technique. It would make
more people do the checkup, who otherwise will pass on it, and risk their
lives..
There is a product out which I've used the last couple of times since I couldn't tollerate the gallon. Here's the link
http://www.halflytely.com/
It uses one pill and only 2 liters of liquid. Their liquid is much more tollerable and I can get all down with ease.
I took an over the counter laxative that was lemon flavored the afternoon before the procedure and the morning of the procedure I took 8 ounces of a non-calorie sweetner from the pharmacy mixed with water and drank two quarts of water in a hour.
I had to "park it" for a while but it wasn't awful tasting. I was dreading drinking a gallon of "chalk" myself but that isn't what they gave me.
@valhalla phil,
Good post. I filed it away for future reference.
I has a nissan fundiplication ten years ago (where they fold over the top part of your stomach and staple it to prevent GERD.) One result of this is that I have to a two-day regimine instead of just the one day, and even that is not very effective, greatly reducing the effectiveness of the colonoscopy. By the time I have "flushed" for two days I am so dehydrated and weak that I can hardly walk and they have trouble finding a suitable vein for the IV line. Then the colonoscopy usually comes back "incluclusive due to improper patient prep."
Valhalla Phil
As a practicing pharmacist for over 30 years I second your recommendation for HalfLytely. I'm overdue for a colonoscopy myself but when I do go in that is the route that I'll be going.
I wonder if they know what the estimated cost will be for this new procedure the article speaks of. Our state BlueCross has been doing everything in its power that it can to get out of paying for these procedures and getting stuck with a $1200 doctor bill is really something I don't need right now.
In Colorado, I had the scope done twice and both times they used dulcolax tablets, take two wait a couple of hours, take two more, etc.
I've had the scope done in Iowa a few times (My Mom died of cancer and my Dad had a field of polyps, so I've been getting scopes for about ten years, every few years). And they want you to drink the gallon of crap. I can barely get it all down, then twice the doctor has told me that I was not cleaned out well. So I'm thinking I'll drink as much of the crap as I can, then I'll do the dulcolax for the rest of it.
Willow- Consider asking for the Halflytely- it's actually a combination of using 1/2 of the volume of liquid that you were drinking AND Dulcolax.
Cutting the volume in half reduces the unpleasantness of the experience by far, far more than half. I've talked to literally dozens of people who have done both and without exception they have said that not only said was Halflytely less unpleasant but that it really wasn't bad at all. And that's something I've been told by maybe 2 out of the hundreds of people who had to drink the gallon.
Um what? The story says is polyps are found, a follow up appointment is needed to remove the polyps. NOT! With my 3 colonoscopies, they have always removed the polyps at that same time. Why would they leave them and make you come back? I don't know of anyone that this happens to. MSNBC, where do you get your info?
Read it again. If they do a virtual colonoscopy, they can't remove the polyps on the spot, because your colon is NOT empty. You have to get prepped, and come back for a regular colonoscopy, so they can remove the polyps. That's one of the disadvantages of this new technique.
Troy - maybe they could remove the polyps virtually.
That is exactly why I will stick with the laxatives! I've had two treatments in 6 years and one of those times they removed a couple benign polyps. Can't imagine having to go back again to remove what could have already been removed!
The prep is worst than the test itself.
I'll second that! The test itself is a breeze.
I agree the test is a breeze. Besides, they put you to sleep and I have found it is a very restful sleep. I'd rather spend an unpleasant day of cleansing to ensure I'm clear of cancer. I have also found a way that makes the gallon of laxative more tollerable. After drinking the 8 oz glass of the stuff, immediately chase it with a table spoon of jello. The jello is one of the items you can ingest the day before the procedure. It doesn't make the drinking of the laxative easier, but it removes the after taste. Do it before you gag!
I don't understand what all the fuss is about. I had a colonoscopy less than six weeks ago. The laxative that my doctor prescribed consisted of an over-the-counter medication mixed with artificially sweetened Gatorade. While the drink was not something that I would choose to quench thirst, it was tolerable. I also requested no anesthesia during the procedure. I hate anesthesia and don't even use Novocaine during dental work. The only uncomfortable part of the procedure was when the probe rounded the first major turn in the colon, and that was bearable. I had worse menstrual cramps when I was a teenager. Since I was awake, the doctor was able to converse with me throughout the entire procedure and could explain anything that looked suspicious. Removal of polyps is completely pain free because there are no pain receptors in the colon. I was wide awake afterward and could have driven myself home. I didn't have to spend the remainder of the day sleeping off the anesthesia. I will definitely request no anesthesia during future colonoscopies.
My doctor prescribes Miralax.......over the counter and pretty cheap at Walmart......It works, tastes fine mixed in a clear type juice like non-red or purple Gator Ade
Some of you might have a high level of tollerance for pain and others might have doctors who prescribe milder laxatives. But the majority of us are prescribed that stuff that tastes like soapy/salty water and we are not fortunate enough to have the high level of pain tollerance.
I hope they will make this Laxative-Free colonoscopy available soon. I'm dreading at the thought of taking gallons of awful-tasting laxative and the sufferings of trips to the toilet causing raw skin around Uranus (haha) is enough torture....let alone someone probing your colon with an object. Ugh!!
The prep is pretty awful, but the laxative can be made bearable by mixing it with Gatorade. I mixed it with the blue kind and it tasted more like apple cider. Of course, I haven't touched apple cider since because now I associate it with a galactic purge, but it was better than trying to choke down a gallon of nasty tasting stuff.
I'll keep that in mind for future reference. I don't like Gatorade to be honest with you; I prefer water with lemon. But if that helps with the taste, i'll try. Ack, ack, ackkkkkkk.
They used magnesium citrate and sorbitol for mine. Neither tasted that bad at all.
I was informed not to eat or drink anything that is blue or purple because it's difficult to tell the difference between those foods and blood in the intestines. White grape juice is fine, but not purple grape juice. Same with Jello. Lemon or lime flavor are acceptable. Grape flavor is not.
MalihLigo and anyone else who has never had the procedure and is dreading it...DON'T listen to anything that anyone else tells you. I dreaded the procedure for years. The first time that my doctor recommended it, I lost my health insurance coverage before I could have it done. That was six years ago. When I was able to obtain health insurance again last year, that was the first thing that my doctor wanted me to do. I put it off for six months because of all the stories I had heard. I almost decided to avoid the procedure entirely because there is no history of cancer in my family. We all seem to die from strokes or heart attacks instead. However, that little nagging voice in my head kept reminding me that colon cancer is avoidable with screening. I had it done about six weeks ago. The doctor found three pre-cancerous polyps. The prep and procedure are no big deal, especially considering that it is so effective in cancer prevention. Don't listen to other patients. Everyone's experience is different. Go ahead and have it done and find out for yourself how you are affected. It might not be as bad as you think and could save your life.
I think I'll take the gallon of laxative over the radiation exposure.
Troy - They're talking about polyps found via CT scan. They can't be "virtually" removed.
That horrific test should of been disbanded long ago!It's been around for 50yrs.Little out dated don't you think?
Colonoscopies have not been around for fifty years. You may have them confused with the old Proctosigmoidoscopy. How that was a horrific test! I know, I had two of them.
Yes Gloria, this is the ultimate violation of your body in the name of good health. The only difference here is that the terrorist is cancer.
Gloria - go ahead. Avoid the procedure and see if you prefer the discomfort of dying from colon cancer when it is entirely preventable through screening. That makes much more sense than being uncomfortable for a short period of time.
Disbanded?............Prefer a lot of radiation from that CT scan at a lot more $$$expense besides................and then if they find anything you are back to square one with a colonoscopy to remove the polyps anyway.
So what exactly Gloria don't you understand about the risks and benefits of this "ancient" [in your eyes] procedure?
I am 55 and have had 4 of the normal types of colonoscopies starting at age 44. Every procedure found and removed polyps. I understand the desirability by some to have a CAT scan and skip the laxative preps needed for a regular colonoscopy--maybe more would actually have a screening done. However, if a polyp is indicated, it just means a regular procedure would be needed anyway, incurring more costs. I do not know what the relative costs of a CAT vs. a colonscopy is--but having both would be more costly, of course. I guess it all comes down to a statistical analysis of how many people really show up with polyps for any test--if if is a low percentage and the CAT is cheaper than the regular one, then by all means. I do worry that the CAT scan of a non-clean colon would not find what a doctor can "see" in real time with a regular scoping procedure. I sure would not want to do both procedures.
With a normal colonoscopy the doctor can take biopsies to check any abnormal area's. I would think that the CT scan would be much cheaper since there is no anesthesia, no equipment cleaning, no punctured colon possibility, etc. so if the majority can go that route and only use the standard version when problems are found or when family history is a factor this should save money in the long run.
Phil - the article doesn't say how many patients would need to have the full colonoscopy done to remove polyps. It's anecdotal but every one I've ever talked to after a colonoscopy said they had one or more polyps removed during the procedure.
That's the kind of thing that makes me suspicious. Everyone who gets the procedure has to have polyps removed? Sounds like a solution in search of a problem.
PRECISELY "EarlyOut". Had a colonoscopy done several years ago (just preventitive..no symptoms) and the dr. said (claimed?) he had to remove three polyps......and then tellling me I had to have a colonoscopy done every five years since polyps were found.
Question not answered in the article - what percentage needed the scope to biopsy polyps after the CAT?
Well, 3 out of 604 that took the CTC version AND the regular test were diagnosed with cancer. Guess that's what the test is for. Ergo, any other biopsy performed was unnecessary, since there was no cancer, and that was the conclusion of the CTC test as well. So, I conclude that the old test is better at finding things that don't matter than the new test...and is much more unpleasant while doing it.
grandfather - There is no way of telling with the scan which polyps were cancerous. You still need the colonoscopy for biopsies.
Plus you still want polyps removed whether they are cancerous or not, biopsy or no biopsy. Benign polyps often develop into malignant ones later.
Btw- is this news? Every doctor I've discussed this with recommends the MRI virtual (NOT the CT virtual) and has them done themselves annually. Not being covered by insurance has been the only obstacle. An Annual MRI virtual does not expose the patient to radiation and so is much safer, and can be backed up by the actual every 5 years or only when polyps develop.
Yes they are already available but lack of insurance coverage means you may not have heard of them yet. They are about a grand if you pay yourself. Expensive, but if you have a genetic history it might be money well spent.
Most? Most? Most? MOST!!!? I mean, really, does anyone ever not find it unpleasant to drink a gallon of goo and spend a day sitting on a toilet. Just say it outright, this is one of the most unpleasant medical procedures you can find that doesn't involve a knife.
A study obviously done by a CT machine manufacturing company, or a group of radiologists. There should be no argument about comfort when it comes to getting LOTS of radiation from a CT scan.
This is not an advance...this is marketing.
OK, sorry everyone for my mistake. Thanks for correcting me.
The prep is worse than the actual procedure so those of you afraid of a "probing" object, relax! You're out and don't even know or feel anything. It's a piece of cake.
Actually, you are not "out" you are given a sedative that prevents short term memory from moving into long term memory. You are alert during the procedure and verbally reacting as required with the Gastroenterologist.
When the effects of the sedative wear off you have no memory of the event because no transfer of short term memory was allowed to occur.
Actually bobbski, I have been put to sleep during my procedures. The nurses wake me up when it is over. I also discussed it with the anestheologist and he said that I would be put to sleep. Different doctors use different procedures.
"Sixty-two percent said the laxative-free method was their preferred method of screening."
Okay, what is wrong with the other 38%? They actually prefer to have to drink a couple gallons of the worst tasting stuff you ever had in your life and then spend the next 12 to 15 hours living on the toilet so you don't shlt yourself to laying down and being passed through a donut?
Apparently, the answer is yes....
JJMurray- Maybe the other 38% are smart enough to realize that polyps are very common and a colonoscopy is required to remove the polyps. Therefore, it is better to go ahead and have the colonoscopy done in the first place rather than having to return later for the inevitable colonoscopy for polyp removal. Or perhaps it's just that the other 38% are more mature and not crybabies like you are over a little discomfort.
Has it not occurred to you that polyps are very common, and that there may be no need to remove them? Medicine has a history of defining normal things as "things that need to be treated."
EarlyOut: Go ahead, you can keep those polyps! Just watch em grow over the years to see what you get in the end!
This is a shiddy article.
OK, so they find a polyp-guess what? Now you have to take the usual prep so they can go in, via colonoscopy, to remove it/them..
And let us consider the amount of radiation your exposed to with a CT scan.. C'mon people THINK
True. CT scans give a lot of radiation.
I was worried about the radiation too. But the very end of the article says this is a different kind CT scan. I'd like to know much is "lower" though compared to a normal xray.
"While CTC uses X-rays, the dose is much lower than that required for a CT scan used to diagnose disease, Zalis said. A study published in 2005 published in the journal Gastroenterology concluded the cancer risks associated with exposure to radiation from CTC are small."
Famous last words. ;)
Lets look at the bright side,,,maybe those who resist the standard treatment will actually have the CT scan, thus saving money down the line when things get much more expensive to treat.
Call me when the can also virtually but totally remove any polyp or cancer found. Otherwise, if one is found, you have to go through the cleansing anyway for a real colonoscopy.
Good grief...can't you people at least keep the same units in you're articles?. 10 milimeters v. 0.6 centimeters? Both in the same sentence. What's up with that?
Grandfather - I noticed the same thing. MSNBC is so unreliable when it comes to editing that I wondered whether the writer made an error. It turns out that 10 millimeters is equivalent to one centimeter, which was mentioned at the top of the article. However, it still would have been more consistent to stick with one unit of measurement than to jump around.
I know of two people who were hospitalized because of shock brought on by severe dehydration resulting from the preparation for standard colonoscopy. One went to the ICU. I wonder how widespread this is (two cases is a lot to hear about personally), and if there isn't a general health issue that needs to be addressed regarding colonoscopy procedures.
I don't know anyone who had that happen. Were these people elderly, with other co-morbidities, such as diabetes? I hate the prep myself, but after you've had to do this 8 or 10 times, and not just for colonoscopies, you just resignedly accept it. So far, they have removed one benign polyp, and told me I have hemorrhoids and diverticuli. Gee, I'm over 60 with 'roids, and diverticuli! Who'd ever imagine that?
One was a relatively elderly gent, around 80. He went to the ICU (a few months ago). The other was a young petite woman (about 100 lb), who took the standard laxative dose. The guess is that the standard dose was way too much for a petite person. Neither had any co-morbidities.
Yeah, well I know for a fact that uncontrolled rapid dehydration from any means can kill you, as it got my wife into acute kidney failure and an extended hospitalization, where the nephrologist was on the fence about putting her on dialysis for days, and she almost died from hyperkalemia. She survived, but not without collateral damage. So yeah, that can be pretty scary.
One of the ways around that is to drink a ton of water during and after the cleansing process, but unfortunately, a lot of people (myself included) cannot do that to the degree required. Now that I take a ton of meds, including diuretics, I have to be really careful about that. I always wished there was a better way, but the limitations of the imaging resolution will miss the smaller tumors and other abnormalities, and when you have a family history of colon cancer, and have had a benign polyp removed, it does make putting up with it a little easier. Not a lot. A little. I have a couple more years before my next one, but when you have cancer elsewhere, they're always doing imaging studies that for some reason require bowel prep. It sucks, but what am I gonna do?
This sounds like the beginning of the end for the old "probe" method. It should be far less costly as well.
Sound more like just another layer of costly examination that has marginal utility. The scan detect polyps but not whether on not they're cancerous. Unless you come up clean on the scan, you'll still need to be violated for a biopsy.
From an article on colon cancer it did describe there is a difference in benign and cancer polyps. Cancerous polyps tend to be flatter and benighn ones tend to be mushroomed. And since CT is a 3D imager - you'd see the shape and go from there.
Had 4 benign polyps removed on my first colonoscopy and was put on a 3-year regime. Next one, 3 small polyps (less than 1 cm) were removed. So the virtual colonoscopy would be a waste of resources and time in my case.
Meanwhile, 10 years from now all the sub 1cm polyps are eating your left leg and most internal organs. Not to worry since the death panels won't treat advanced cancer undetected with virtual pretend diagnostics.
My biggest gripe about the current screening method is that you have to have someone with you (to drive you home). I'm single, with no family in the area, and no friends I would be comfortable having with me for such a personal event. No sedation would be an ideal solution for my predicament.
June ..... where I live in Fl they WILL NOT let you take a cab either. BS.
June - I am in the exact same situation as you. I have no family in the area in which I live and none of my friends are close enough that I felt comfortable with asking them to take time off from work to babysit me. Keep in mind that the person whom you ask to drive you can wait in the waiting room. No one has to accompany you to where the procedure is performed or in the recovery area. Second, consider have the procedure done without anesthesia. I did and will never, ever have it done with anesthesia. It was not painful. There is a bit of discomfort when the probe turns the first major bend in the colon, but that was not as bad as menstrual cramps I had as a teenager and is over almost as soon as it starts. Removal of the probe is completely painless, as is removal of polyps (there are no pain receptors in the colon). I was wide awake afterward and completely capable of driving myself home.
I took one look at the big fat hose laying on the instrument table next to me, and couldn't wait to get knocked out.
I think the colonoscopy is the best way to look for polyps because they find the small ones and can also remove the polyps as they find them. The laxative is just a down side but it would be nice if they found something else you could take without having to drink a gallon of the stuff. If you have the CT version and they find polyps, wouldn't you have to do the laxative method anyway for them to go in and remove them? If you don't have the polyps removed I think people are taking a huge risk in even giving them the chance to turn into cancer. There are too many needless deaths due to colon cancer. If it's caught early, you have pretty much a 100% cure rate. My grandmother had colon cancer surgery when she was in her 70's. They got it all in surgery and she didn't have to do chemo or any other follow-up treatment. She passed away when she was 88 of natural causes. God Bless her soul.
I refuse to have a colonoscopy ( had 1 in my 30's ) I'm 55 now. I simply have a fecal test done with my PAP test which is done every 2 years. All clear so far.
You are tremendously foolish. The fecal test that is performed when you have a pap smear does not catch polyps in their early stages of development, when they are easily removable and have not become cancerous.