The Case for Virtual Colonoscopies

Like most people of a certain age (50 for most), my doctor advised it was time for a colon screening. Thanks to persuasive campaigning from the medical community and health advocates, I was well aware that colorectal cancer is America’s third most common cancer-related cause of death, preventable through proper screening.

“We are seeing an alarming increase in colon cancer over the past several years, particularly in younger patients,” confirms Dr. David Kipper, a renowned Beverly Hills internist and diagnostician. “We think it might be related to the rise in obesity. If there is a family history of colon cancer, the odds go way up. So now the recommendations are to begin screenings at age 45.”

What does a screening entail?

Most gastroenterologists look to the conventional colonoscopy method or optical colonoscopy, an outpatient procedure where a flexible fibrotic tube is inserted inside a sedated patient’s rectum. The doctor uses a light and camera at the end of the tube to look through the colon and remove any polyps along the way since polyps are a precursor to colon cancer. Polyps requiring further testing are sent to a lab to be biopsied.

I was hopeful I’d breeze through the optical colonoscopy procedure like so many friends and family members had. What my gastro doctor failed to caution is that my redundant colon, with its longer than normal with extra twists and turns, made it impossible to get the colonoscope through the entire organ. The probing irritated (and maybe even perforated) my colon. I woke up from a twilight sleep with severe cramping and bloating that lasted for weeks. What’s worse, she couldn’t declare my colonoscopy a success.

So I was faced with exploring an alternative—a virtual colonoscopy (CT Colonography), a procedure I wish I’d known about beforehand.

I visited with Dr. Ross Goldberg at LSG Imaging in Santa Monica, CA where he provides virtual colonoscopies. Personable, direct, and enthusiastic, Dr. Goldberg explained the procedure in clear and practical terms. When we were done with the consult, I wondered why everyone didn’t choose to have a virtual colonoscopy. 

“We need to break through with GI doctors and internists to get them—and the public—to understand how virtual colonoscopies are more accurate, safer and cheaper, “ Dr. Goldberg explains. “It’s a minimally-invasive procedure that does not require sedation, which means no downtime and you wouldn’t need someone to drive you to the procedure.” And, unlike the optical colonoscopy, patients on anticoagulants can continue taking them for the procedure.

With a virtual colonoscopy, polyps are located but not removed. How much of a drawback is this? “Polyps under 5 mm (milliliters) do not need to be removed, and should not,” Dr. Goldberg emphasizes. “There is only a 1 in 10,000 chance of it growing and they don’t grow that fast anyway. Doctors have this mindset that every single polyp must be removed and that increases the risk for complications, such as perforation.” If a problematic polyp is detected during a virtual colonoscopy, the patient will be immediately referred to their internist for a traditional colonoscopy.

Dr. Goldberg believes a virtual colonoscopy is more effective for a redundant colon. “Because it’s computer generated, we can see end to end in all directions, like a video game,” he says. “We can see polyps behind a fold.”

There is a concern among doctors that a virtual colonoscopy misses detecting smaller polyps. “We have no problem seeing 2 mm (millimeter) polyps,” insists Dr. Goldberg. “We see them all of the time. More importantly, they are of no significance and do not need to be removed, but are anyway at an unnecessary risk.”

To undergo a virtual colonoscopy, you will need to prep and empty your colon the day before the procedure. On the day of, a soft, flexible catheter is inserted to blow carbon dioxide gas (CO2) into the rectum. Using a low-level dose of radiation, a CT scanner takes images of your abdomen and pelvis, and in less than 15 minutes, it’s over. The CO2 is absorbed by the colon, which means no post-procedure cramping. There is also little to no risk of perforation or infection. 

Many major private health insurers cover the procedure (mine did), and up to 40 states require insurers to cover it. In 2018, a bipartisan bill was introduced to include virtual colonoscopy colon cancer screenings in Medicare coverage. 

“Not all insurance companies cover these exams,” cautions Dr. Kipper. “And you need to check that you are covered if you need follow up on the virtual colonoscopy. Insurance carriers may not cover two tests in the same year, making the colonoscopy an out-of-pocket expense.”

My virtual colonoscopy experience was all I hoped for—a short procedure with no residual cramping. Afterwards, while viewing my twisted colon on the computer screen with Dr. Goldberg, it became even clearer why a traditional colonoscopy was not an option for me. Dr. Goldberg also gave me a visual tour of my abdominal and pelvic area. If he detected abnormalities in my kidney, liver or pancreas, I’d let my internist know and follow up with different exams.

A virtual colonoscopy is not recommended for people with inflammatory bowel diseases, such as ulcerative colitis and Crohn’s disease. But it works for people with other gut issues such as Irritable Bowel Syndrome (IBS), SIBO (small intestine bacteria overgrowth), lactose intolerance, diverticulitis, and other conditions, but check with your doctor first.

If a patient decides they want a virtual colonoscopy, Dr. Kipper suggests they ask their doctor to set this up. “The patient can sometimes contact the imaging center directly,” he says, “but the imaging centers need a physician to interpret the test and give the patient the results and establish a plan, so going through their doctor is the easiest way to do this. 

 “I believe the virtual study has a place in our diagnostic tool bag,” continues Dr. Kipper. “It’s great for those who don’t want the invasive component of the conventional study. But I wouldn’t compare it as superior to the conventional study.”

My bottom line? It’s important for doctors and internists to explain the positives and negatives of virtual colonoscopies for people who can’t (or are reluctant to) undergo a conventional colonoscopy.  And we should do our own research, too. But ultimately what matters most is getting a colon screening, whatever method we choose.